Pre-treatment plasma renin activity significantly influenced the maximum antihypertensive effect of olmesartan, whereas azelnidipine's effect was independent of patient background characteristics.
RCT (n=29)
What factors influence the antihypertensive response to olmesartan medoxomil versus azelnidipine in patients with mild to moderate essential hypertension?
Pre-treatment plasma renin activity may serve as a useful predictor of responsiveness when selecting between olmesartan and azelnidipine for hypertension management.
SUMMARY: The objectives of this study were to identify the factors influencing antihypertensive response to the angiotensin receptor blocker, olmesartan medoxomil, or the calcium channel blocker, azelnidipine, and to discuss the possibility of utilizing them as predictors for drug selection prior to therapy. A two-way crossover study of olmesartan medoxomil and azelnidipine was conducted in 29 patients with mild to moderate essential hypertension. The 24-hour ambulatory blood pressure measurements (ABPM) and plasma drug concentrations were obtained on the first and at the end of each treatment period, and were analyzed using population pharmacokinetic/pharmacodynamic (PK/PD) modeling approach. The population PK/PD models considering circadian variations in baseline blood pressure well described the observed plasma drug concentrations and 24-hour ABPM profiles. Pre-treatment plasma renin activity (PRA) was identified as a significant covariate on the maximum drug effect (E(max)) of olmesartan, whereas azelnidpine E(max) was independent of patient background characteristics investigated. No patient was found to have a high E(max) to one agent who also had a high E(max) to the other. In conclusion, the effects of olmesartan medoxomil and azelnidipine were modestly correlated with pharmacokinetic profiles, and the pre-treatment PRA level could be a useful determinant of responsiveness in selecting olmesartan medoxomil and azelnidipine.
Tanigawara et al. (Thu,) conducted a rct in mild to moderate essential hypertension (n=29). Olmesartan medoxomil vs. Azelnidipine was evaluated on Maximum drug effect (Emax) on 24-hour ambulatory blood pressure measurements (ABPM). Pre-treatment plasma renin activity significantly influenced the maximum antihypertensive effect of olmesartan, whereas azelnidipine's effect was independent of patient background characteristics.