Key result
Azilsartan-chlortalidone combination enhances 24-hour blood pressure control and adherence in comorbid hypertension.
Why the study?
Many patients with arterial hypertension fail to achieve blood pressure control due to pseudoresistance linked to low treatment adherence, metabolic syndrome, and hypervolemia. Addressing this requires a rational combination therapy that simultaneously suppresses the renin-angiotensin-aldosterone system and adjusts volemic status.
Does the combination of azilsartan medoxomil and chlortalidone improve blood pressure control, adherence, and long-term cardiovascular prognosis in comorbid patients with arterial hypertension?
Does the combination of azilsartan medoxomil and chlortalidone improve blood pressure control, adherence, and long-term cardiovascular prognosis in comorbid patients with arterial hypertension?
This review highlights that combined therapy with azilsartan medoxomil and chlortalidone targets key pathogenetic mechanisms of hypertension in comorbid patients, potentially improving blood pressure control, adherence, and long-term cardiovascular prognosis.
Answers are grounded in this paper and cite their sources.
May support azilsartan-chlortalidone for BP control in comorbid hypertension; leaves open RCTs on adherence and prognosis.
Arterial hypertension (AH) is a key modifiable risk factor for cardiovascular complications. At the same time, a lack of blood pressure control is reported in AH patients. In general, noncompliance with target values is associated with pseudoresistance based on low adherence to therapy, metabolic syndrome and hypervolemia. In this setting, a rational choice of combined antihypertensive therapy requires simultaneous suppression of the reninangiotensinaldosterone system and adjustment of volemic status. Chlortalidone, one of the key representatives of thiazidelike diuretics, is characterized by a longer halflife providing a stable 24hour antihypertensive effect and a proven decrease in a risk of stroke and heart failure (including that associated resistant AH). Unlike other angiotensin II receptor blockers, azilsartan medoxomil demonstrates the most stable and strongest antihypertensive effect, as well as beneficial metabolic effects partially mediated by agonism to PPAR-γ receptors. The combination of azilsartan medoxomil and chlortalidone affects key pathogenetic mechanisms of hypertension in comorbid patients contributing to achieving target blood pressure levels, increasing adherence to the therapy, and improving longterm cardiovascular prognosis. KEYWORDS: arterial hypertension, resistant hypertension, chlortalidone, azilsartan medoxomil, metabolic syndrome, angiotensin II receptor blockers, thiazidelike diuretics. FOR CITATION: Ostroumova O.D., Kochetkov A.I., Dubinina A.V., Telkova S.S. Breaking barriers: from pseudoresistance to efficient control of blood pressure. Russian Medical Inquiry. 2026;10(9):600–607 (in Russ.). DOI: 10.32364/2587-6821-2026-10-9-2
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Ostroumova et al. (2026) conducted a review in Arterial hypertension, including pseudoresistant and resistant hypertension with metabolic syndrome. Azilsartan medoxomil and chlortalidone combination was evaluated. Combining azilsartan medoxomil and chlortalidone targets key pathogenetic mechanisms in comorbid hypertension, providing stable 24-hour blood pressure control and improved adherence.
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