Key result
Switching to olmesartan or azilsartan significantly decreased the urinary albumin-to-creatinine ratio from 13.8 to 9.0 mg/g Cre and reduced urinary angiotensinogen in patients with uncontrolled hypertension.
Why the study?
Does switching to olmesartan or azilsartan reduce blood pressure, albuminuria, and intrarenal renin-angiotensin system activity in patients with uncontrolled hypertension on conventional ARBs?
RCT (n=24)
Randomly switched
No
Does switching to olmesartan or azilsartan reduce blood pressure, albuminuria, and intrarenal renin-angiotensin system activity in patients with uncontrolled hypertension on conventional ARBs?
Absolute Event Rate: 9% vs 13.8%
p-value: p=0.0096
Switching to olmesartan or azilsartan in patients with uncontrolled hypertension on conventional ARBs significantly reduces blood pressure, albuminuria, and intrarenal renin-angiotensin system activity.
Supports switching to olmesartan or azilsartan for albuminuria reduction in uncontrolled hypertension on other ARBs; extends RCT evidence on differential intrarenal RAS effects.
PURPOSE: Olmesartan and azilsartan decrease blood pressure more effectively than other angiotensin receptor blockers (ARBs). ARBs additionally decrease the urinary albumin to creatinine ratio (UACR), a urinary albumin marker, and urinary angiotensinogen (u-AGT), an intrarenal renin-angiotensin system activity marker. We examined the effects of these ARBs on blood pressure, UACR, and u-AGT in patients with uncontrolled hypertension. METHODS: Patients with uncontrolled hypertension treated with conventional ARBs, excluding olmesartan and azilsartan, for over 8 weeks were enrolled. We randomly switched patients from their prior ARBs to either olmesartan or azilsartan, and followed them for 24 weeks. RESULTS: Systolic blood pressure (SBP), diastolic blood pressure (DBP), and central systolic blood pressure (cSBP) significantly decreased at 24 weeks. UACR and u-AGT also decreased at 24 weeks in both groups. There were no significant differences in SBP, DBP, cSBP, UACR, or u-AGT between the groups. Therefore, we combined both groups for further analyses. After combining, SBP (160.5 ± 16.4 to 139.6 ± 15.6 mm Hg, P < 0.0001), DBP (88.4 ± 13.7 to 80.7 ± 13.2 mm Hg, P = 0.008), cSBP (167.4 ± 20.8 to 146.6 ± 24.6 mm Hg, P < 0.0001), UACR (13.8 to 9.0 mg/g Cre, P = 0.0096), and u-AGT (4.13 to 2.32 μg/g Cre, P = 0.0074) significantly decreased at 24 weeks. Patients with microalbuminuria (UACR ≥ 30 mg/g Cre) had significantly greater ΔUACR (-39.4 vs 0.27, P = 0.0024) and Δu-AGT (-11.9 vs -0.61, P = 0.0235) than patients without microalbuminuria. The changes in u-AGT were significantly associated with changes in UACR (r = 0.411, P = 0.046); however, there was no significant relationship between the changes in u-AGT and those in SBP or DBP. CONCLUSION: Olmesartan and azilsartan decreased blood pressure, UACR, and u-AGT more than the other ARBs, and exerted depressor and renoprotective effects.
No takes yet. Share an insight, caveat, or question.
Takami et al. (2018) conducted an RCT in Uncontrolled hypertension (n=24). Olmesartan or Azilsartan vs. Baseline (prior conventional ARBs) was evaluated on Urinary albumin to creatinine ratio (UACR) (p=0.0096). Switching to olmesartan or azilsartan significantly decreased the urinary albumin-to-creatinine ratio from 13.8 to 9.0 mg/g Cre and reduced urinary angiotensinogen in patients with uncontrolled hypertension.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: