Key result
Switching from olmesartan to another ARB was associated with lower blood pressure goal maintenance compared to continuing olmesartan (72.2% vs 78.7%; OR 0.707; 95% CI 0.555-0.899).
Why the study?
Does switching from olmesartan to other ARBs reduce blood pressure goal maintenance in hypertensive patients?
Cohort (n=3,412)
Does switching from olmesartan to other ARBs reduce blood pressure goal maintenance in hypertensive patients?
Switching from olmesartan to other ARBs in patients with controlled hypertension is associated with a decreased likelihood of maintaining blood pressure goals.
Answers are grounded in this paper and cite their sources.
May warrant caution switching from olmesartan in controlled hypertension; leaves open causal superiority versus confounding in this cohort.
This study assessed blood pressure (BP) goal maintenance in patients controlled with olmesartan monotherapy after switching to another angiotensin type II receptor blocker (ARB). Hypertensive patients prescribed olmesartan monotherapy were identified from GE Healthcare's Centricity electronic medical record between 2007 and 2011. After documentation of BP goal (<140/90 mm Hg) attainment, patients were placed into the continuation cohort if olmesartan monotherapy was maintained or into the switch cohort if they were changed to irbesartan, losartan, or valsartan. Follow-up assessments were the first BP measurement 28 to 390 days after attaining BP goal (continuation cohort) or after prescribing an alternative ARB (switch cohort). Of 3412 patients included (3027 continuation cohort, 385 switch cohort), 52% were women and mean age was 58.0 years. In the switch cohort, 310 (80.5%) were switched to losartan (n=236), irbesartan (n=58), or valsartan (n=16) monotherapy and 75 (19.5%) were switched to combination antihypertensive therapy. Mean baseline and follow-up BP were 122.5/75.8 mm Hg and 126.6/77.6 mm Hg, respectively, in the continuation cohort (P<.001) and 123.5/75.4 mm Hg and 129.6/78.5 mm Hg, respectively, in the switch cohort (P<.001). BP goal maintenance was 78.7% and 72.2% in the continuation and switch cohort, respectively (odds ratio, 0.707; 95% confidence interval, 0.555-0.899). Patients who continued on olmesartan monotherapy after attaining BP goal had a higher percentage of BP goal maintenance than patients who switched therapy.
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Saseen et al. (2013) conducted a cohort in Hypertension (n=3,412). Switching to another ARB (irbesartan, losartan, or valsartan) or combination therapy vs. Continuation of olmesartan monotherapy was evaluated on Blood pressure goal maintenance (<140/90 mm Hg) (OR 0.707, 95% CI 0.555-0.899). Switching from olmesartan to another ARB was associated with lower blood pressure goal maintenance compared to continuing olmesartan (72.2% vs 78.7%; OR 0.707; 95% CI 0.555-0.899).
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