Key result
Azilsartan-medoxomil/Chlorthalidone significantly lowered mean diastolic blood pressure compared to Olmesartan-medoxomil/Hydrochlorothiazide (WMD -2.64; 95% CI -2.78 to -2.51; p<0.00001).
Why the study?
This study intended to compare the efficacy and side effect profile of AZI-M/CT versus OLM/HCTZ in hypertensive patients.
Does Azilsartan-medoxomil/Chlorthalidone improve blood pressure reduction compared to Olmesartan-medoxomil/Hydrochlorothiazide in hypertensive patients?
Meta-Analysis (n=3,146)
Does Azilsartan-medoxomil/Chlorthalidone improve blood pressure reduction compared to Olmesartan-medoxomil/Hydrochlorothiazide in hypertensive patients?
Azilsartan-medoxomil/Chlorthalidone provides greater diastolic blood pressure reduction than Olmesartan-medoxomil/Hydrochlorothiazide but is associated with a higher risk of adverse events.
Azilsartan-medoxomil/Chlorthalidone may be preferred for greater diastolic BP reduction; extends meta-analytic support for the combination while flagging higher adverse event risk.
Aims: This study intends to compare AZI-M/CT's efficacy and side effect profile to the OLM/HCTZ in hypertensive patients. Materials and methods: Online databases (PubMed, Google Scholar, and ClinicalTrials.gov) were searched until January 15, 2022, for original articles exploring the effects of AZI-M/CT on pertinent outcomes among hypertensive patients in contrast to OLM/HCTZ. Data on baseline characteristics and endpoints were extracted. Review Manager version 5.4.1 and STATA 16.0 were used for analyses. Risk ratios (RR) and the weighted mean differences (WMD) with corresponding 95% confidence intervals were calculated. Results: Four studies were included having 3146 patients in total (AZI-M/CT: 1931 and OLM/HCTZ: 1215). The pooled analysis exhibited that compared to OLM-HCTZ, mean DBP was significantly lower in the AZI-M/CT group (WMD –2.64 [-2.78, -2.51]; p= <0.00001, I2= 1%), whereas no significant differences were noted in mean SBP (WMD –2.95 [-6.64,0.73]; p= 0.12, I2=100%) and achievement of target blood pressure (RR 0.95 [0.84,1.07]; p= 0.36, I2= 80%). Additionally, the risk of any TEAE (RR 1.11 [1.03, 1.20]; p= 0.007, I2= 51%) and serious adverse events RR 1.58 [1.20, 2.08]; p= 0.001, I2= 11%) was significantly higher in the AZI-M/CT group. However, no significant differences were observed in the risk of mortality between the two groups (RR 0.74 [0.14, 3.91; p = 0.72, I2= 0%). Conclusions: Our pooled analysis indicates that AZI-M/CT is more efficient at lowering blood pressure in elderly hypertensive patients than OLM/HCTZ. However, given the limited number of studies, positive results should be discretely re-evaluated and require further research.
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Mahima Khatri (2022) conducted a meta-analysis in Hypertension (n=3,146). Azilsartan-medoxomil/Chlorthalidone (AZI-M/CT) vs. Olmesartan-medoxomil/Hydrochlorothiazide (OLM/HCTZ) was evaluated on Mean diastolic blood pressure (DBP) (WMD -2.64, 95% CI -2.78, -2.51, p=<0.00001). Azilsartan-medoxomil/Chlorthalidone significantly lowered mean diastolic blood pressure compared to Olmesartan-medoxomil/Hydrochlorothiazide (WMD -2.64; 95% CI -2.78 to -2.51; p<0.00001).
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