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A randomized titrate-to-target study comparing fixed-dose combinations of azilsartan medoxomil and chlorthalidone with olmesartan and hydrochlorothiazide in stage-2 systolic hypertension. J Hypertens 2018; 36:947-956. [PMID: 29334491 PMCID: PMC5862000 DOI: 10.1097/hjh.0000000000001647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background: Azilsartan medoxomil (AZL-M), an angiotensin II receptor blocker, has been developed in fixed-dose combinations (FDCs) with chlorthalidone (CTD). Objective/methods: We compared FDCs of AZL-M/CTD 20/12.5 mg once daily titrated to 40/25 mg if needed or AZL-M/CTD 40/12.5 mg once daily titrated to 80/25 mg if needed with an olmesartan medoxomil (OLM)-hydrochlorothiazide (HCTZ) 20/12.5 mg FDC once daily titrated to 40/25 mg if needed in a randomized, double-blind, 8-week study of 1085 participants with clinic SBP 160–190 mmHg and DBP 119 mmHg or less. Titration to higher doses occurred at week 4 if BP was at least 140/90 mmHg (≥130/80 mmHg if diabetes or chronic kidney disease). The primary endpoint was change from baseline in clinic SBP; 24-h ambulatory BP monitoring was also measured. Results: Greater reductions in clinic SBP from a baseline of 165 mmHg were observed (P < 0.001) in both AZL-M/CTD arms (−37.6 and −38.2 mmHg) versus OLM/HCTZ (−31.5 mmHg), despite greater dose titration in the OLM/HCTZ group. At 8 weeks, both AZL-M/CTD FDCs reduced 24-h SBP more than OLM/HCTZ (−26.4 and −27.9 versus −20.7 mmHg; both P < 0.001), and higher proportions in both AZL-M/CTD groups achieved target BP compared with the OLM/HCTZ group (69.4 and 68.9 versus 54.7%, both P < 0.001). Adverse events leading to drug discontinuation occurred in 6.2, 9.5, and 3.1% with the AZL-M/CTD lower and higher doses, and OLM/HCTZ, respectively. Conclusion: This large, titration-to-target BP study demonstrated AZL-M/CTD FDCs to have superior antihypertensive efficacy compared with the maximum approved dose of OLM/HCTZ.
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Izzo JL, Khan SU, Saleem O, Osmond PJ. Ambulatory 24-hour cardiac oxygen consumption and blood pressure-heart rate variability: effects of nebivolol and valsartan alone and in combination. JOURNAL OF THE AMERICAN SOCIETY OF HYPERTENSION : JASH 2015; 9:526-35. [PMID: 26116459 PMCID: PMC7457394 DOI: 10.1016/j.jash.2015.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 03/23/2015] [Accepted: 03/23/2015] [Indexed: 01/02/2023]
Abstract
We compared an angiotensin receptor blocker (valsartan; VAL), a beta-blocker (nebivolol; NEB) and the combination of NEB/VAL with respect to 24-hour myocardial oxygen consumption (determined by 24-hour ambulatory heart rate-central systolic pressure product [ACRPP]) and its components. Subjects with hypertension (systolic blood pressure >140 or diastolic blood pressure >90; n = 26) were studied in a double-blinded, double-dummy, forced-titration, crossover design with 3 random-order experimental periods: VAL 320 mg, NEB 40 mg, and NEB/VAL 320/40 mg daily. After 4 weeks of each drug, ambulatory pulse wave analysis (MobilOGraph) was performed every 20 minutes for 24 hours. All three treatments resulted in nearly identical brachial and central systolic blood pressures. NEB alone or in combination with VAL resulted in lower ACRPP (by 11%-14%; P < .001 each) and heart rate (by 18%-20%; P < .001 each) compared with VAL, but stroke work (ACRPP per beat) was lower with VAL. Relative and adjusted variability (standard deviation and coefficient of variation) of heart rate were also lower with NEB and NEB/VAL than VAL. Results in African Americans, the majority subpopulation, were similar to those of the entire treatment group. We conclude that the rate-slowing effects of NEB cause ambulatory cardiac myocardial oxygen consumption to be lower with NEB monotherapy or NEB/VAL combination therapy than with VAL monotherapy. NEB/VAL is not superior to NEB alone in controlling heart rate, blood pressure, or ACRPP. Heart rate variability but not ACRPP variability is reduced by NEB or the combination NEB/VAL. There is no attenuation of beta-blocker-induced rate-slowing effects of in African Americans.
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Affiliation(s)
- Joseph L Izzo
- Department of Medicine, State University of New York at Buffalo, Erie County Medical Center, Buffalo, NY, USA.
| | - Safi U Khan
- Department of Medicine, State University of New York at Buffalo, Erie County Medical Center, Buffalo, NY, USA
| | - Osman Saleem
- Department of Medicine, State University of New York at Buffalo, Erie County Medical Center, Buffalo, NY, USA
| | - Peter J Osmond
- Department of Medicine, State University of New York at Buffalo, Erie County Medical Center, Buffalo, NY, USA
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Cushman WC, Bakris GL, White WB, Weber MA, Sica D, Roberts A, Lloyd E, Kupfer S. Azilsartan Medoxomil Plus Chlorthalidone Reduces Blood Pressure More Effectively Than Olmesartan Plus Hydrochlorothiazide in Stage 2 Systolic Hypertension. Hypertension 2012; 60:310-8. [PMID: 22710649 DOI: 10.1161/hypertensionaha.111.188284] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Azilsartan medoxomil, an effective, long-acting angiotensin II receptor blocker, is a new treatment for hypertension that is also being developed in fixed-dose combinations with chlorthalidone, a potent, long-acting thiazide-like diuretic. We compared once-daily fixed-dose combinations of azilsartan medoxomil/chlorthalidone force titrated to a high dose of either 40/25 mg or 80/25 mg with a fixed-dose combination of the angiotensin II receptor blocker olmesartan medoxomil plus the thiazide diuretic hydrochlorothiazide force titrated to 40/25 mg. The design was a randomized, 3-arm, double-blind, 12-week study of 1071 participants with baseline clinic systolic blood pressure 160 to 190 mm Hg and diastolic blood pressure ≤119 mm Hg. Patients had a mean age of 57 years; 59% were men, 73% were white, and 22% were black. At baseline, mean clinic blood pressure was 165/96 mm Hg and 24-hour mean blood pressure was 150/88 mm Hg. Changes in clinic (primary end point) and ambulatory systolic blood pressures at week 12 were significantly greater in both azilsartan medoxomil/chlorthalidone arms than in the olmesartan/hydrochlorothiazide arm (
P
<0.001). Changes in clinic systolic blood pressure (mean±SE) were −42.5±0.8, −44.0±0.8, and −37.1±0.8 mm Hg, respectively. Changes in 24-hour ambulatory systolic blood pressure were −33.9±0.8, −36.3±0.8, and −27.5±0.8 mm Hg, respectively. Adverse events leading to permanent drug discontinuation occurred in 7.9%, 14.5%, and 7.1% of the groups given azilsartan medoxomil/chlorthalidone 40/25 mg, azilsartan medoxomil/chlorthalidone 80/25 mg, and olmesartan/hydrochlorothiazide 40/25 mg, respectively. This large, forced-titration study has demonstrated superior antihypertensive efficacy of azilsartan medoxomil/chlorthalidone fixed-dose combinations compared with the maximum approved dose of olmesartan/hydrochlorothiazide.
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Affiliation(s)
- William C. Cushman
- From the University of Tennessee College of Medicine (W.C.C.), Memphis, TN; The University of Chicago Medicine (G.L.B.), Chicago, IL; University of Connecticut School of Medicine (W.B.W.), Farmington, CT; Downstate Medical Center (M.A.W.), Brooklyn, NY; Virginia Commonwealth University (D.S.), Richmond, VA; Takeda Global Research and Development Center, Inc (A.R., E.L., S.K.), Deerfield, IL
| | - George L. Bakris
- From the University of Tennessee College of Medicine (W.C.C.), Memphis, TN; The University of Chicago Medicine (G.L.B.), Chicago, IL; University of Connecticut School of Medicine (W.B.W.), Farmington, CT; Downstate Medical Center (M.A.W.), Brooklyn, NY; Virginia Commonwealth University (D.S.), Richmond, VA; Takeda Global Research and Development Center, Inc (A.R., E.L., S.K.), Deerfield, IL
| | - William B. White
- From the University of Tennessee College of Medicine (W.C.C.), Memphis, TN; The University of Chicago Medicine (G.L.B.), Chicago, IL; University of Connecticut School of Medicine (W.B.W.), Farmington, CT; Downstate Medical Center (M.A.W.), Brooklyn, NY; Virginia Commonwealth University (D.S.), Richmond, VA; Takeda Global Research and Development Center, Inc (A.R., E.L., S.K.), Deerfield, IL
| | - Michael A. Weber
- From the University of Tennessee College of Medicine (W.C.C.), Memphis, TN; The University of Chicago Medicine (G.L.B.), Chicago, IL; University of Connecticut School of Medicine (W.B.W.), Farmington, CT; Downstate Medical Center (M.A.W.), Brooklyn, NY; Virginia Commonwealth University (D.S.), Richmond, VA; Takeda Global Research and Development Center, Inc (A.R., E.L., S.K.), Deerfield, IL
| | - Domenic Sica
- From the University of Tennessee College of Medicine (W.C.C.), Memphis, TN; The University of Chicago Medicine (G.L.B.), Chicago, IL; University of Connecticut School of Medicine (W.B.W.), Farmington, CT; Downstate Medical Center (M.A.W.), Brooklyn, NY; Virginia Commonwealth University (D.S.), Richmond, VA; Takeda Global Research and Development Center, Inc (A.R., E.L., S.K.), Deerfield, IL
| | - Andrew Roberts
- From the University of Tennessee College of Medicine (W.C.C.), Memphis, TN; The University of Chicago Medicine (G.L.B.), Chicago, IL; University of Connecticut School of Medicine (W.B.W.), Farmington, CT; Downstate Medical Center (M.A.W.), Brooklyn, NY; Virginia Commonwealth University (D.S.), Richmond, VA; Takeda Global Research and Development Center, Inc (A.R., E.L., S.K.), Deerfield, IL
| | - Eric Lloyd
- From the University of Tennessee College of Medicine (W.C.C.), Memphis, TN; The University of Chicago Medicine (G.L.B.), Chicago, IL; University of Connecticut School of Medicine (W.B.W.), Farmington, CT; Downstate Medical Center (M.A.W.), Brooklyn, NY; Virginia Commonwealth University (D.S.), Richmond, VA; Takeda Global Research and Development Center, Inc (A.R., E.L., S.K.), Deerfield, IL
| | - Stuart Kupfer
- From the University of Tennessee College of Medicine (W.C.C.), Memphis, TN; The University of Chicago Medicine (G.L.B.), Chicago, IL; University of Connecticut School of Medicine (W.B.W.), Farmington, CT; Downstate Medical Center (M.A.W.), Brooklyn, NY; Virginia Commonwealth University (D.S.), Richmond, VA; Takeda Global Research and Development Center, Inc (A.R., E.L., S.K.), Deerfield, IL
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