Key result
Azilsartan medoxomil 40 mg and 80 mg reduced clinic systolic blood pressure significantly more than ramipril 10 mg (-20.6 and -21.2 mm Hg vs -12.2 mm Hg, respectively) after 24 weeks.
Why the study?
Does azilsartan medoxomil reduce blood pressure more effectively than ramipril in patients with stage 1 or 2 hypertension?
RCT (n=884)
Double-blind
Randomized
Yes
Does azilsartan medoxomil reduce blood pressure more effectively than ramipril in patients with stage 1 or 2 hypertension?
Azilsartan medoxomil at 40 mg and 80 mg daily provides superior blood pressure reduction compared to ramipril 10 mg daily in patients with stage 1-2 hypertension, with better overall tolerability.
Answers are grounded in this paper and cite their sources.
Supports azilsartan medoxomil over ramipril for superior BP reduction in stage 1-2 hypertension; extends RCT evidence on ARB versus ACEI efficacy.
Drug therapy often fails to control hypertension. Azilsartan medoxomil (AZL-M) is a newly developed angiotensin II receptor blocker with high efficacy and good tolerability. This double-blind, controlled, randomised trial compared its antihypertensive efficacy and safety vs the angiotensin-converting enzyme inhibitor ramipril (RAM) in patients with clinic systolic blood pressure (SBP) 150-180 mm Hg. Patients were randomised (n=884) to 20 mg AZL-M or 2.5 mg RAM once daily for 2 weeks, then force-titrated to 40 or 80 mg AZL-M or 10 mg RAM for 22 weeks. The primary endpoint was change in trough, seated, clinic SBP. Mean patient age was 57±11 years, 52.4% were male, 99.5% were Caucasian. Mean baseline BP was 161.1±7.9/94.9±9.0 mm Hg. Clinic SBP decreased by 20.6±0.95 and 21.2±0.95 mm Hg with AZL-M 40 and 80 mg vs12.2±0.95 mm Hg with RAM (P<0.001 for both AZL-M doses). Adverse events leading to discontinuation were less frequent with AZL-M 40 and 80 mg (2.4% and 3.1%, respectively) than with RAM (4.8%). These data demonstrated that treatment of stage 1-2 hypertension with AZL-M was more effective than RAM and better tolerated.
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Bönner et al. (2013) conducted an RCT in Stage 1 or 2 hypertension (n=884). Azilsartan medoxomil vs. Ramipril 10 mg once daily was evaluated on Change from baseline to week 24 in trough, seated, clinic systolic blood pressure (SBP) (MD -9.0, p=<0.001). Azilsartan medoxomil 40 mg and 80 mg reduced clinic systolic blood pressure significantly more than ramipril 10 mg (-20.6 and -21.2 mm Hg vs -12.2 mm Hg, respectively) after 24 weeks.
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