Amlodipine plus olmesartan superior to monotherapy in difficult-to-treat hypertensive populations

The combination of amlodipine and olmesartan was demonstrated to be superior to monotherapy with either agent in difficult-to-treat hypertensive populations in a subgroup analysis of the registrational trial for this combination therapy. These results were presented at the 23rd Annual Scientific Meeting of the American Society of Hypertension, New Orleans, May 14–17, 2008.

The study examined efficacy among black and Hispanic/Latino patients, patients with diabetes, and patients with high body mass index (BMI) because the blood pressure of these populations is typically hard to control, said Suzanne Oparil, MD, director of the Vascular Biology and Hypertension Program, University of Alabama, Birmingham.

In the randomized, double-blind, placebo-controlled study of 1,940 patients, subgroups were matched for baseline blood pressure and were then randomized to 8 weeks of treatment with 1 of 12 treatment regimens: amlodipine 5 or 10 mg/d as monotherapy; olmesartan 10, 20, or 40 mg/d as monotherapy; 1 of the 6 possible combinations of these doses of amlodipine and olmesartan; or placebo.

In almost all dose comparisons in all ethnic groups, mean reductions in SBP and DBP were significantly greater with the amlodipine/olmesartan combinations than with olmesartan monotherapy. The magnitude of reduction with the combination in black patients (29/16 mmHg) approached that observed in nonblack patients (31/20 mmHg).

Mean reductions in blood pressure were similar between Hispanic/Latino (29/21 mmHg) and non-Hispanic/non-Latino subgroups (30/19 mmHg). In most comparisons, more patients reached target blood pressure with combination therapy than with monotherapy.

The combination was also more effective than monotherapy in patients with diabetes and in patients with high BMI, observed George Bakris, MD, professor of medicine at the University of Chicago.

“The antihypertensive effect of the combination was similar in patients with and without diabetes, and regardless of BMI. If you started on the combination you were more likely to achieve blood pressure goal,” Dr Bakris said.