Why the study?
Does increasing hydrochlorothiazide from 25 mg to 50 mg daily improve blood pressure control in patients with stage 2 systolic hypertension not at goal on olmesartan 40 mg and hydrochlorothiazide 25 mg?
Does increasing hydrochlorothiazide from 25 mg to 50 mg daily improve blood pressure control in patients with stage 2 systolic hypertension not at goal on olmesartan 40 mg and hydrochlorothiazide 25 mg?
Titrating hydrochlorothiazide to 50 mg daily in patients with stage 2 systolic hypertension not at goal on olmesartan and 25 mg HCTZ provides additional blood pressure reduction with acceptable tolerability.
May inform HCTZ titration decisions in uncontrolled hypertension; hypothesis-generating and requires randomized confirmation.
The authors studied the combination of hydrochlorothiazide (HCTZ) 50 mg/d plus olmesartan medoxomil (OM) 40 mg/d in stage 2 systolic hypertension during an extension phase of an open-label 12-week dose titration study. Subjects whose blood pressure remained above 120/80 mm Hg (n=105) on OM 40/HCTZ 25 mg/d subsequently received OM 40/HCTZ 50 mg/d for 4 weeks. Increasing HCTZ from 25 mg/d to 50 mg/d decreased systolic blood pressure by 3.6 mm Hg, increased BP control rates (<140/90 mm Hg) from 70.4% to 77.5%, and increased BP normalization rates (<120/80 mm Hg) from 15.4% to 27.8%. The combination was well tolerated. Compared with OM 40 mg/d monotherapy, neither dose of HCTZ affected serum potassium, but both increased serum glucose by about 5%. There was a dose-dependent increase in uric acid but no acute gout attacks. OM 40/HCTZ 50 mg/d is an effective strategy for managing stage 2 systolic hypertension.
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Izzo et al. (2007) studied this question.
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