Why the study?
Does olmesartan 20 mg/day plus HCTZ 12.5 mg/day improve blood pressure goal achievement compared to olmesartan 40 mg/day in hypertensive patients uncontrolled on olmesartan 20 mg/day?
Does olmesartan 20 mg/day plus HCTZ 12.5 mg/day improve blood pressure goal achievement compared to olmesartan 40 mg/day in hypertensive patients uncontrolled on olmesartan 20 mg/day?
In patients with essential hypertension uncontrolled on olmesartan 20 mg/day, stepping up to combination therapy with HCTZ 12.5 mg/day resulted in higher blood pressure goal achievement than titrating olmesartan to 40 mg/day.
Adding HCTZ 12.5 mg to olmesartan 20 mg outperforms dose titration for BP goal achievement; extends RCT evidence favoring early combination therapy in uncontrolled hypertension.
AIMS: Guidelines recommend blood pressure (BP) in hypertensive patients should be <140 systolic BP (SBP) and <90 diastolic BP (DBP) mmHg. This analysis assessed goal rate achievement in hypertensive patients receiving olmesartan-based treatment in the OLMEBEST study. METHODS: Patients with essential hypertension (DBP > or = 90 mmHg and <110 mmHg) received open-label olmesartan medoxomil 20 mg/day (n = 2306). After 8 weeks, patients with DBP > or = 90 mmHg (n = 627) were randomized to 4 weeks' double-blind treatment with olmesartan 40 mg/day monotherapy or olmesartan 20 mg/day plus hydrochlorothiazide (HCTZ) 12.5 mg/day. For this analysis, the numbers and proportions of patients who achieved SBP < 140 mmHg and/or DBP < 90 mmHg at the end of the 4 weeks were calculated. RESULTS: In patients who achieved DBP normalization (<90 mmHg) at week 8 (n = 1546) and continued open-label olmesartan 20 mg/day, 66.7% achieved SBP/DBP < 140/90 mmHg at Week 12. In patients who did not achieve DBP normalization at Week 8, 26.8% of those randomized to olmesartan 40 mg/day and 42.5% of those randomized to olmesartan 20 mg/day plus HCTZ 12.5 mg/day achieved a SBP/DBP < 140/90 mmHg at Week 12. CONCLUSION: Olmesartan 40 mg/day and olmesartan 20 mg/day plus HCTZ 12.5 mg/day allow substantial proportions of patients to achieve BP goals.
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Vivencio Barrios (2009) studied this question.
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