September 9, 2010
Antihypertensive efficacy and safety of olmesartan medoxomil and ramipril in elderly patients with mild to moderate essential hypertension: the ESPORT study
Key Result
Olmesartan medoxomil produced greater baseline-adjusted office SBP reductions compared to ramipril (17.8 vs 15.7 mmHg, P<0.01) in elderly patients with essential hypertension.
Study Design
Type
RCT (n=1,102)
Blinding
double-blind
Randomization
randomized
Structured PICO
Does olmesartan medoxomil improve blood pressure reduction compared to ramipril in elderly patients with mild to moderate essential hypertension?
P
Population
1102 treated or untreated elderly patients aged 65-89 years with mild to moderate essential arterial hypertension (office sitting DBP 90-109 mmHg and/or office sitting SBP 140-179 mmHg)
I
Intervention
Olmesartan medoxomil 10 mg once-daily, with dose doubling at 2 and 6 weeks up to 40 mg if blood pressure not normalized
C
Comparator
Ramipril 2.5 mg once-daily, with dose doubling at 2 and 6 weeks up to 10 mg if blood pressure not normalized
O
Outcome
Baseline-adjusted office systolic and diastolic blood pressure reductions after 12 weeks of treatmentsurrogate
In elderly patients with essential hypertension, olmesartan provides significantly greater and more homogeneous 24-hour blood pressure reduction compared to ramipril, with a similar safety profile.
Main Result
Absolute Event Rate: 17.8% vs 15.7%
p-value: p=<0.01
Abstract
OBJECTIVE: To compare the efficacy and safety of the angiotensin II antagonist olmesartan medoxomil (O) and the ACE inhibitor ramipril (R) in elderly patients with essential arterial hypertension. METHODS: After a 2-week placebo wash-out 1102 treated or untreated elderly hypertensive patients aged 65-89 years (office sitting diastolic blood pressure, DBP, 90-109 mmHg and/or office sitting systolic blood pressure, SBP, 140-179 mmHg) were randomized double-blind to 12-week treatment with O 10 mg or R 2.5 mg once-daily. After the first 2 and 6 weeks doses could be doubled in non-normalized blood pressure (BP) < 140/90 mmHg for nondiabetic and < 130/80 mmHg for diabetic) individuals, up to 40 mg for O and 10 mg for R. Office BPs were assessed at randomization, after 2, 6 and 12 weeks of treatment, whereas 24-h ambulatory BP was recorded at randomization and after 12 weeks. RESULTS: In the intention-to-treat population (542 patients O and 539 R) after 12 weeks of treatment baseline-adjusted office SBP and DBP reductions were greater (P < 0.01) with O [17.8 (95% confidence interval: 16.8/18.9) and 9.2 (8.6/9.8) mmHg than with R 15.7 (14.7/16.8) and 7.7 (7.1/8.3) mmHg. BP normalization rate was also greater under O (52.6 vs. 46.0% R, P < 0.05). In the subgroup of patients with valid ambulatory BP recording (318 O and 312 R) the reduction in 24-h average BP was larger (P < 0.05) with O SBP: 11.0 (12.2/9.9) and DBP: 6.5 (7.2/5.8) mmHg than with R 9.0 (10.2/7.9) and 5.4 (6.1/4.7) mmHg. The larger blood pressure reduction obtained with O was particularly evident in the last 6 h from the dosing interval; a better homogeneity of the 24-h BP control with O was confirmed by higher smoothness indices. The proportion of patients with drug-related adverse events was comparable in the two groups (3.6 O vs. 3.6% R), as well as the number of patients discontinuing study drug because of a side effect (14 O vs. 19 R). CONCLUSION: In elderly patients with essential arterial hypertension O provides an effective, prolonged and well tolerated BP control, representing a useful option among first-line drug treatments of hypertension in this age group.