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Burnier M, Redon J, Volpe M. Single-Pill Combination with Three Antihypertensive Agents to Improve Blood Pressure Control in Hypertension: Focus on Olmesartan-Based Combinations. High Blood Press Cardiovasc Prev 2023; 30:109-121. [PMID: 36696054 PMCID: PMC10090015 DOI: 10.1007/s40292-023-00563-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/09/2023] [Indexed: 01/26/2023] Open
Abstract
Blood pressure control remains an unmet clinical need. Only about half of patients achieve their blood pressure (BP) targets and of these, the majority require combination and double or triple therapies. International guidelines recommend the association of drugs with complementary mechanisms of action and, in particular, the combination of renin-angiotensin system (RAS) inhibitors, calcium channel blockers (CCBs), and diuretics. Among the various angiotensin receptor blockers, olmesartan (OM) is available as a monotherapy and in dual and triple single-pill combinations (SPCs) with amlodipine (AML) and/or hydrochlorothiazide (HCTZ). Several phase III and IV studies, together with real-world studies, have demonstrated the additional benefits of combining OM either with AML or with HCTZ in terms of BP control and target BP achievements both in the general population and in special subgroups of hypertensive patients, such as the elderly, diabetic, chronic kidney disease or obese patients. Ambulatory BP monitoring studies assessing 24h BP have also demonstrated that dual, as well as triple, OM-based SPCs induce a more sustained and smoother BP reduction than placebo and monotherapy. Furthermore, triple OM-based SPC has been shown to improve therapeutic adherence in hypertensive patients compared to free combinations. The availability of OM combined with HCTZ, AML or both at different dosages makes it a valuable option to customize therapy based on the levels of BP and the clinical characteristics of hypertensive patients.
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Affiliation(s)
- Michel Burnier
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
| | - Josep Redon
- Cardiovascular and Renal Research Group, INCLIVA Research Institute, University of Valencia, Valencia, Spain
- CIBERObn, ISCIII, Madrid, Spain
| | - Massimo Volpe
- Department of Clinical and Molecular Medicine, University of Rome Sapienza, Rome, Italy
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2
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Gholap DP, Huse R, Dipake S, Lande MK. Silica supported lanthanum trifluoroacetate and trichloroacetate as an efficient and reusable water compatible Lewis acid catalyst for synthesis of 2,4,5-triarylimidazoles via a solvent-free green approach. RSC Adv 2023; 13:2090-2103. [PMID: 36712612 PMCID: PMC9832349 DOI: 10.1039/d2ra07021a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 12/10/2022] [Indexed: 01/13/2023] Open
Abstract
In the present research article, we have developed solid heterogenous silica supported lanthanum trifluoroacetate and trichloroacetate as green Lewis acid catalysts. These catalysts were synthesized by a novel, simple, cheap, clean, and environment friendly method. The physicochemical properties of the prepared catalysts were well studied and characterized by sophisticated spectroscopic techniques such as FTIR, TGA, XRD, EDX, SEM, TEM and BET analysis. The catalyst was utilized in the synthesis of arylimidazole derivatives via green protocols under solvent-free conditions at 70 °C with a higher yield, mild reaction conditions and a short reaction time. The catalyst works superiorly in water as well as in various organic solvents as a reusable and easily recoverable catalyst.
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Affiliation(s)
| | - Ramdas Huse
- Department of Chemistry, Dr Babasaheb Ambedkar Marathwada University Aurangabad Maharashtra India
| | - Sudarshan Dipake
- Department of Chemistry, Dr Babasaheb Ambedkar Marathwada University Aurangabad Maharashtra India
| | - Machhindra K Lande
- Department of Chemistry, Dr Babasaheb Ambedkar Marathwada University Aurangabad Maharashtra India
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3
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Sarzani R, Laureti G, Gezzi A, Spannella F, Giulietti F. Single-pill fixed-dose drug combinations to reduce blood pressure: the right pill for the right patient. Ther Adv Chronic Dis 2022; 13:20406223221102754. [PMID: 35769133 PMCID: PMC9235298 DOI: 10.1177/20406223221102754] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 04/28/2022] [Indexed: 11/17/2022] Open
Abstract
Arterial hypertension is one of the major causes of cardiovascular morbidity and mortality worldwide. Effective and sustained reduction in blood pressure is essential to reduce individual cardiovascular risk. In daily clinical practice, single-pill fixed-dose combinations of different drug classes are important therapeutic resources that could improve both treatment adherence and cardiovascular risk management by targeting distinct pathophysiological mechanisms. The aim of this practical narrative review is to help physicians choosing the right single-pill fixed-dose combination for the right patient in the daily clinical practice, based on the individual clinical phenotype and cardiovascular risk profile.
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Affiliation(s)
- Riccardo Sarzani
- Internal Medicine and Geriatrics, 'Hypertension Excellence Centre' of the European Society of Hypertension, IRCCS, INRCA, via della Montagnola 81, 60127 Ancona, Italy
| | - Giorgia Laureti
- Internal Medicine and Geriatrics, 'Hypertension Excellence Centre' of the European Society of Hypertension, IRCCS, INRCA, Ancona, Italy
| | - Alessandro Gezzi
- Internal Medicine and Geriatrics, 'Hypertension Excellence Centre' of the European Society of Hypertension, IRCCS, INRCA, Ancona, Italy
| | - Francesco Spannella
- Internal Medicine and Geriatrics, 'Hypertension Excellence Centre' of the European Society of Hypertension, IRCCS, INRCA, Ancona, Italy
| | - Federico Giulietti
- Internal Medicine and Geriatrics, 'Hypertension Excellence Centre' of the European Society of Hypertension, IRCCS, INRCA, Ancona, Italy
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Development of an analytical method for the determination and quantification of n-nitrosodimethylamine in olmesartan by hplc-ms/ms. Microchem J 2022. [DOI: 10.1016/j.microc.2022.107402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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5
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Wang M, Shi H, Shao S, Lu K, Wang H, Yang Y, Gong Z, Zuo Y, Gao S. Montmorillonite promoted photodegradation of amlodipine in natural water via formation of surface complexes. CHEMOSPHERE 2022; 286:131641. [PMID: 34325263 DOI: 10.1016/j.chemosphere.2021.131641] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/18/2021] [Accepted: 07/20/2021] [Indexed: 06/13/2023]
Abstract
The photolysis of amlodipine (AML) as a ubiquitous pollutant in natural water has been extensively studied. Montmorillonite (MMT), a major component of suspended particles in surface aquifers, plays key roles in the natural transportation and transformation of organic contaminants in the environment. However, literature has scarcely focused on whether and how suspended particles affect the phototransformation of AML. This study systematically investigated the phototransformation behavior of AML in MMT suspensions under simulated sunlight. The results obtained showed that MMT significantly enhanced the photolysis of AML. The photodegradation of AML in 0.05 g/L MMT suspension reached 92.2 % after 3 h irradiation under the simulated sunlight. The photodecomposition followed the pseudo-first-order kinetic with a rate constant of 0.803 h-1 in the presence of 0.05 g/L MMT, which is about 19 times larger than that in the absence of MMT (0.0421 h-1). Further mechanistic investigation suggested that MMT accelerated the photolysis of AML by the formation of surface complexes between cationic amino groups of AML and the negatively charged sites on MMT surface, which greatly facilitated light absorption and electron transfer for the production of cationic radical AML+·. Meanwhile, the hydroxyl radicals generated by irradiated MMT also played an important role in the photocatalytic degradation of AML. The probable photodegradation pathways of AML in MMT suspension further supported the proposed mechanisms. The toxicity evaluation of phototransformation products of AML with ECOSAR program indicated that photolysis could reduce its potential threats. These findings reveal an important and previously overlooked phototransformation mechanisms of AML in the presence of MMT clays, which is of importance in assessing the environmental fate of other similar organic contaminants.
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Affiliation(s)
- Mengjie Wang
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing, 210023, China
| | - Huanhuan Shi
- School of Ecology and Environment, Zhengzhou University, Zhengzhou, 450001, China
| | - Shuai Shao
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing, 210023, China
| | - Kun Lu
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing, 210023, China
| | - Hanyu Wang
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing, 210023, China
| | - Yun Yang
- Department of Civil and Environmental Engineering, Hong Kong University of Science and Technology, Hong Kong SAR, China
| | - Zhimin Gong
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing, 210023, China
| | - Yuegang Zuo
- University of Massachusetts Dartmouth, 285 Old Westport Road, North Dartmouth, MA, 02747-2300, USA.
| | - Shixiang Gao
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing, 210023, China.
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Almutairy BK, Alshetaili A, Alali AS, Ahmed MM, Anwer MK, Aboudzadeh MA. Design of Olmesartan Medoxomil-Loaded Nanosponges for Hypertension and Lung Cancer Treatments. Polymers (Basel) 2021; 13:2272. [PMID: 34301030 PMCID: PMC8309359 DOI: 10.3390/polym13142272] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 12/13/2022] Open
Abstract
Olmesartan medoxomil (OLM) is one of the prominent antihypertensive drug that suffers from low aqueous solubility and dissolution rate leading to its low bioavailability. To improve the oral bioavailability of OLM, a delivery system based on ethylcellulose (EC, a biobased polymer) nanosponges (NSs) was developed and evaluated for cytotoxicity against the A549 lung cell lines and antihypertensive potential in a rat model. Four OLM-loaded NSs (ONS1-ONS4) were prepared and fully evaluated in terms of physicochemical properties. Among these formulations, ONS4 was regarded as the optimized formulation with particle size (487 nm), PDI (0.386), zeta potential (ζP = -18.1 mV), entrapment efficiency (EE = 91.2%) and drug loading (DL = 0.88%). In addition, a nanosized porous morphology was detected for this optimized system with NS surface area of about 63.512 m2/g, pore volume and pore radius Dv(r) of 0.149 cc/g and 15.274 Å, respectively, measured by nitrogen adsorption/desorption analysis. The observed morphology plus sustained release rate of OLM caused that the optimized formulation showed higher cytotoxicity against A549 lung cell lines in comparison to the pure OLM. Finally, this system (ONS4) reduced the systolic blood pressure (SBP) significantly (p < 0.01) as compared to control and pure OLM drug in spontaneously hypertensive rats. Overall, this study provides a scientific basis for future studies on the encapsulation efficiency of NSs as promising drug carriers for overcoming pharmacokinetic limitations.
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Affiliation(s)
- Bjad K. Almutairy
- Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj 11942, Saudi Arabia; (B.K.A.); (A.A.); (A.S.A.); (M.M.A.)
| | - Abdullah Alshetaili
- Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj 11942, Saudi Arabia; (B.K.A.); (A.A.); (A.S.A.); (M.M.A.)
| | - Amer S. Alali
- Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj 11942, Saudi Arabia; (B.K.A.); (A.A.); (A.S.A.); (M.M.A.)
| | - Mohammed Muqtader Ahmed
- Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj 11942, Saudi Arabia; (B.K.A.); (A.A.); (A.S.A.); (M.M.A.)
| | - Md. Khalid Anwer
- Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj 11942, Saudi Arabia; (B.K.A.); (A.A.); (A.S.A.); (M.M.A.)
| | - M. Ali Aboudzadeh
- Institut des Sciences Analytiques et de Physico-Chimie pour l’Environnement et les Matériaux, University Pau & Pays Adour, 64000 Pau, France
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Jadhav CK, Nipate AS, Chate AV, Kamble PM, Kadam GA, Dofe VS, Khedkar VM, Gill CH. Room temperature ionic liquid promoted improved and rapid synthesis of highly functionalized imidazole and evaluation of their inhibitory activity against human cancer cells. J CHIN CHEM SOC-TAIP 2021. [DOI: 10.1002/jccs.202000468] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Chetan K. Jadhav
- Department of Chemistry Dr. Babasaheb Ambedkar Marathwada University Aurangabad Maharashtra India
| | - Amol S. Nipate
- Department of Chemistry Dr. Babasaheb Ambedkar Marathwada University Aurangabad Maharashtra India
| | - Asha V. Chate
- Department of Chemistry Dr. Babasaheb Ambedkar Marathwada University Aurangabad Maharashtra India
| | - Pratiksha M. Kamble
- Department of Chemistry Dr. Babasaheb Ambedkar Marathwada University Aurangabad Maharashtra India
| | - Ganesh A. Kadam
- Department of Chemistry Dr. Babasaheb Ambedkar Marathwada University Aurangabad Maharashtra India
| | - Vidya S. Dofe
- Department of Chemistry Deogiri College of Science Aurangabad Maharashtra India
| | - Vijay M. Khedkar
- Department of Pharmaceutical Chemistry, School of Pharmacy Vishwakarma University Pune India
| | - Charansingh H. Gill
- Department of Chemistry Dr. Babasaheb Ambedkar Marathwada University Aurangabad Maharashtra India
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Effect of antihypertensive treatment on 24-h blood pressure variability: pooled individual data analysis of ambulatory blood pressure monitoring studies based on olmesartan mono or combination treatment. J Hypertens 2019; 36:720-733. [PMID: 29045341 PMCID: PMC5862001 DOI: 10.1097/hjh.0000000000001608] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Objective: To evaluate the impact of olmesartan alone or combined with one to three antihypertensive drugs on 24-h blood pressure variability (BPV) and on distribution of BP reduction in a pooled individual data analysis of 10 double-blind, randomized, ambulatory BP monitoring (ABPM) studies. Methods: ABPMs were performed before and after 6–12 weeks of treatment with placebo (n = 119), active control monotherapy [n = 1195, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), dihydropyridine calcium channel blockers (DCCBs)] olmesartan monotherapy (n = 1410), active control dual combination [n = 79, DCCB + thiazide diuretic (TD)], olmesartan dual combination (n = 637, DCCB or TD), and triple combination therapy (n = 102, DCCB+TD). 24-h BPV was calculated as unweighted or weighted SD of the mean BP, and average real variability. BP control was assessed by smoothness index and treatment-on-variability index. Results: The greatest effect on 24-h systolic BPV/diastolic BPV was observed under olmesartan triple [−2.6/−1.9; −1.9/−1.3; −1.4/−1.3 mmHg] and active control dual combination [−1.8/−1.4; −1.9/−1.5; −1.2/−1.1 mmHg]. Smoothness indexes and treatment-on-variability indexes were significantly (P = 0.0001) higher under olmesartan dual (1.53/1.22, 1.67/1.29, 2.05/1.59), olmesartan triple (2.47/1.85, 2.80/2.06, 3.64/2.67), or active control dual combination (1.70/1.26, 1.85/1.33, 2.29/1.65) than under monotherapies (control: 0.86/0.73, 0.80/0.65, 1.01/0.82; olmesartan: 1.02/0.86, 0.95/0.78, 1.23/1.00). They were also greater in patients receiving high-dose olmesartan monotherapy or high-dose olmesartan dual combination than in the corresponding low-dose group. Conclusion: Olmesartan plus a DCCB and/or a TD produces a larger, more sustained, and smoother BP reduction than placebo and monotherapies, a desirable feature for a more effective prevention of the cardiovascular consequences of uncontrolled hypertension.
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9
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Miyoshi T, Onoue G, Ito H. Effect of Switching to Azilsartan From Fixed-Dose Combination of an Angiotensin II Receptor Blocker and Calcium Channel Blocker or a Thiazide in Patients With Hypertension. J Clin Med Res 2019; 11:202-207. [PMID: 30834043 PMCID: PMC6396784 DOI: 10.14740/jocmr3723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 12/31/2018] [Indexed: 12/15/2022] Open
Abstract
Background Despite the availability of antihypertensive treatments, fewer than half of patients who receive treatment successfully achieve blood pressure (BP) goals. The purpose of this study was to evaluate the effect of switching to azilsartan 40 mg from a fixed-dose combination tablet of an angiotensin II receptor blocker (ARB) and amlodipine at 5 mg or azelnidipine at 16 mg (ARB/CCB) or an ARB and hydrochlorothiazide (HCT) at 6.25 mg or 12.5 mg (ARB/HCT) on BP. Methods This prospective, multicenter, open-labeled, single-arm study included 40 patients treated with a fixed-dose combination tablet of an ARB/CCB or an ARB/HCT, which was switched to azilsartan 40 mg after enrollment. The primary outcome was the change in BP from baseline to the 24-week follow-up. Results Of the 40 patients who completed this study, 33 did not require changes in their antihypertensive medications after switching to azilsartan, and their BP did not change from baseline to follow-up. However, the systolic BP in seven patients was elevated at 12 weeks, and amlodipine at 5 mg was therefore added; these patients’ baseline medications were an ARB/CCB (n = 6) and an ARB/HCT (n = 1). In all patients, the serum potassium level was slightly increased after switching to azilsartan at 6 months, while the serum creatinine, hemoblobinA1c, and lipid profile did not change. Conclusions Azilsartan at 40 mg did not result in a greater decrease in BP than a fixed-dose combination tablet of an ARB/CCB or an ARB/HCT. However, our findings suggest a substantial BP-lowering effect of azilsartan at 40 mg in patients with hypertension.
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Affiliation(s)
- Toru Miyoshi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | | | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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10
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Zhou T, Huang X, Cai X, Xie L. Combined treatment of irbesartan and diltiazem ameliorates endothelium dependent vasodilatation in hypertensives. Clin Exp Hypertens 2017; 39:612-618. [PMID: 28613098 DOI: 10.1080/10641963.2017.1306537] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Tingting Zhou
- Fujian Medical University, Fujian Hypertension Research Institute, Fuzhou, P.R. China
| | - Xiaodong Huang
- Fujian Hypertension Research Institute, First Affiliated Hospital of Fujian Medical University, Fuzhou, PR China
| | - Xiaoqi Cai
- Fujian Hypertension Research Institute, First Affiliated Hospital of Fujian Medical University, Fuzhou, PR China
| | - Liangdi Xie
- Fujian Hypertension Research Institute, First Affiliated Hospital of Fujian Medical University, Fuzhou, PR China
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11
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Zhang X, Zhang H, Ma Y, Che W, Hamblin MR. Management of Hypertension Using Olmesartan Alone or in Combination. Cardiol Ther 2017; 6:13-32. [PMID: 28258390 PMCID: PMC5446820 DOI: 10.1007/s40119-017-0087-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Indexed: 12/19/2022] Open
Abstract
Hypertension is one of the most significant and consistent risk factors for many cardiovascular diseases. The global prevalence of hypertension has dramatically increased over recent years. Life-style and genetic factors are generally considered to be primarily responsible for the incidence of hypertension. Concerning the high morbidity rate, setting up an updated standard for hypertensive patients becomes indispensable. According to the widely accepted standard treatments for hypertension, these four basic principles should be taken into account: low dosage; medication should provide long term-control; combination therapies are becoming common; personalized treatments are a newer approach. In most patients with hypertension, adequate control of BP can be achieved with combined therapy. Therefore, antihypertensive agents with complementary mechanisms are now recommended. In this review, we focus on the pharmacology, antihypertensive efficacy, and adverse events (AEs) of olmesartan medoxomil, either alone or in combination with other antihypertensive medications. In conclusion, olmesartan medoxomil, is an angiotensin II receptor blocker with an excellent efficacy in the reduction and stabilization of blood pressure. When combined with calcium channel blockers (CCBs) and diuretics, olmesartan medoxomil has a better effect on controlling BP and reducing AEs in patients.
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Affiliation(s)
- Xiaoshen Zhang
- Department of Cardiology, Shanghai Tenth Hospital of Tongji University, Shanghai, 200072, China.,Tongji University Cancer Institute, Tongji University School of Medicine, Shanghai, 200092, China.,Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Han Zhang
- Department of Cardiology, Shanghai Tenth Hospital of Tongji University, Shanghai, 200072, China
| | - Yuxia Ma
- Department of Internal Medicine, Cangzhou Central Hospital, Cangzhou, China
| | - Wenliang Che
- Department of Cardiology, Shanghai Tenth Hospital of Tongji University, Shanghai, 200072, China
| | - Michael R Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, 02114, USA. .,Department of Dermatology, Harvard Medical School, Boston, MA, 02115, USA. .,Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, 02139, USA.
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12
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Comparative study of the efficacy of olmesartan/amlodipine vs. perindopril/amlodipine in peripheral blood pressure after missed dose in type 2 diabetes. J Hypertens 2016; 34:359-67. [PMID: 26867060 DOI: 10.1097/hjh.0000000000000793] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Combination therapy is needed to control blood pressure (BP) in a large number of hypertensive patients with diabetes mellitus. Adherence to treatment is a major clinical problem; therefore, the time duration of the antihypertensive action of a drug determines BP control when a dose is skipped. OBJECTIVES The aim was to determine whether the fixed-dose combination of olmesartan/amlodipine provides equal efficacy and safety as the perindopril/amlodipine combination when a drug dose is missed. METHODS In this noninferiority trial with a randomized, double-blind, double-dummy parallel group, controlled design, 260 patients received either olmesartan 20-40 mg/amlodipine 5-10 mg or perindopril 4-8 mg/amlodipine 5-10 mg for 24 weeks. The main outcome was the sitting office DBP after 24 weeks of treatment at 48 h from last administration. RESULTS The olmesartan/amlodipine combination reached noninferiority criteria in reduction of office DBP after 24 weeks of treatment and after the missed dose, compared with the perindopril/amlodipine combination (-11.7 and -10.5 mmHg, respectively). Office SBP and pulse pressure were significantly lower in both groups after 24 weeks of treatment and 48 h after the missed dose, observing a trend to greater SBP reduction in the olmesartan/amlodipine group. CONCLUSIONS The combination olmesartan/amlodipine is safe, well tolerated, and as effective as the combination of perindopril/amlodipine in the control of essential hypertension in patients with diabetes mellitus. A missed dose does not leave the patients unprotected in both treatments; however, a faster control with less dose increment is observed with olmesartan/amlodipine.
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13
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Kourlaba G, Gialama F, Tsioufis K, Maniadakis N. A literature review to evaluate the clinical and economic value of olmesartan for the treatment of hypertensive patients. Int J Cardiol 2016; 221:60-74. [PMID: 27404671 DOI: 10.1016/j.ijcard.2016.06.115] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 05/19/2016] [Accepted: 06/21/2016] [Indexed: 12/15/2022]
Abstract
The objective of the present study was to systematically review the clinical and economic outcomes of olmesartan as monotherapy or in combination with other antihypertensive agents in the treatment of hypertension. A literature search was performed using PubMed and the Cochrane library until December 2015, with no limit on publication date. Eligible studies were selected using predetermined inclusion and exclusion criteria, limiting articles to those published in the English language. Background information of the study, participants' characteristics and study outcomes were collected. Meta-analysis of data was not performed. Fifty-five studies were included, of which fifty investigated the clinical efficacy of olmesartan and five the cost-effectiveness of olmesartan. In general results from clinical trials evaluating the efficacy of olmesartan as monotherapy and as combination therapy demonstrated that olmesartan provided better antihypertensive blood pressure-lowering efficacy and was generally well tolerated compared with other antihypertensive agents. Results from economic evaluations indicated that olmesartan may be more cost-effective than other ARBs such as losartan, valsartan, irbesartan and candesartan, having the potential of decreasing the overall medical costs of care for patients with hypertension. Evidence from the present systematic review confirms the antihypertensive efficacy and good safety profile of olmesartan both as monotherapy and as combination therapy. Olmesartan was also found to be cost-effective compared with other ARBs, though this area has yet relatively poor evidence and needs to further be explored.
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Affiliation(s)
- G Kourlaba
- EVROSTON LP, Chatzigianni Mexi 5, 115 28 Athens, Greece; Collaborative Center of Clinical Epidemiology and Outcomes Research (CLEO), Non-Profit Company, Chatzigianni Mexi 5, 115 28 Athens, Greece.
| | - F Gialama
- EVROSTON LP, Chatzigianni Mexi 5, 115 28 Athens, Greece
| | - K Tsioufis
- 1st Depertment of Cardiology, University of Athens, Hippocration Hospital, Vassilisis Sophias 114, 115 27, Greece
| | - N Maniadakis
- Department of Health Services Organization, National School of Public Health, 196 Alexandras Avenue, 115 21 Athens, Greece
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Levi M, Pasqua A, Cricelli I, Cricelli C, Piccinni C, Parretti D, Lapi F. Patient Adherence to Olmesartan/Amlodipine Combinations: Fixed Versus Extemporaneous Combinations. J Manag Care Spec Pharm 2016; 22:255-62. [PMID: 27003555 PMCID: PMC10398216 DOI: 10.18553/jmcp.2016.22.3.255] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Lack of adherence to prescribed therapies is often a cause of suboptimal blood pressure control in patients with hypertension. To enhance patients' adherence to treatment, fixed-dose combinations of active substances with complementary mechanisms of action have been developed. An angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker (ARB) is often combined with a calcium channel blocker. Olmesartan is the most used ARB in combination therapy. In Italy, in September 2011, a fixed-dose combination of olmesartan/amlodipine (olmesartan/amlodipine 20/5 mg, 40/5 mg, or 40/10 mg) was introduced to treat patients with hypertension for whom control of blood pressure is not reached with either olmesartan or amlodipine alone. Prior research on adherence to olmesartan/amlodipine combinations was carried out in local contexts (e.g., claims databases of Italian regions or local health authorities), and/or it was limited by the fact that adherence was assessed against monotherapies already known for their low compliance profile, such as diuretics. OBJECTIVE To compare adherence with olmesartan/amlodipine fixed-dose combination (FDC) and extemporaneous combination in primary care in Italy. METHODS A nationwide, population-based study was conducted by using the Health Search IMS Health Longitudinal Patient Database. Patients aged > 17 years, affected by hypertension and treated with the FDC or extemporaneous combination of olmesartan/amlodipine, were identified. Adherence to these 2 therapeutic regimens was estimated by calculating the proportion of days covered (PDC). Patients were classified into 3 levels of adherence: high (PDC ≥ 80%), intermediate (PDC = 40%-79%), or low (PDC < 40%). RESULTS In the 6-month follow-up, FDC showed higher adherence compared with an extemporaneous combination (55.1% vs. 15.9%, P < 0.001). This difference was confirmed in a multivariable logistic regression model clustered on patient identifier (odds ratio = 6.65; 95% CI = 3.10-14.26; P < 0.001). The proportion of patients adherent to FDC varied from 60.4% for the 40/5 mg formulation to 47.5% for the 40/10 mg formulation. CONCLUSIONS These findings suggest that higher adherence may be achieved with FDCs than with extemporaneous combinations. To improve the degree of adherence, general practitioners may consider prescribing fixed combinations of antihypertensive agents as soon as monotherapies fail to achieve the expected therapeutic objective.
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Affiliation(s)
- Miriam Levi
- Research Fellow, Department of Health Sciences, University of Florence, Florence, Italy
| | - Alessandro Pasqua
- Chief Statistician, Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Iacopo Cricelli
- General Director, Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Claudio Cricelli
- President, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Carlo Piccinni
- Postdoctoral Researcher, Department of Medical and Surgical Sciences−Pharmacology Unit, University of Bologna, Bologna, Italy
| | - Damiano Parretti
- General Practitioner, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Francesco Lapi
- Research Director, Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
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15
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Susa N, Nishida Y, Yada Y, Nakayama T, Asai S, Takahashi Y. Comparative effect of fixed-dose combination tablets of candesartan cilexetil/amlodipine versus olmesartan medoxomil/azelnidipine on laboratory parameters in patients with hypertension: a retrospective cohort study. Clin Exp Hypertens 2015; 38:173-9. [PMID: 26453437 DOI: 10.3109/10641963.2015.1081214] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We conducted a retrospective cohort study to evaluate and compare the long-term effects of two single-pill fixed-dose combinations (FDCs), candesartan/amlodipine and olmesartan/azelnidipine, on laboratory parameters in patients in routine clinical practice. We identified an equal number of new users (n = 182) of a candesartan/amlodipine (8/5 mg/day) FDC tablet (CAN/AML users) and a propensity-score matched cohort (n = 182) receiving an olmesartan/azelnidipine (20/16 mg/day) FDC tablet (OLM/AZ users). Generalized estimating equations were used to estimate and compare the effects of the drugs on serum levels of creatinine, estimated glomerular filtration rate (eGFR), blood urea nitrogen (BUN), uric acid, sodium, potassium, aspartate aminotransferase, and alanine aminotransferase levels up to 12 months after the start of study drug administration. There was a significant increase of serum creatinine level and a significant decrease of eGFR from the baseline period to during the exposure period in both CAN/AML and OLM/AZ users, and a significant increase of BUN level in CAN/AML users. However, there were no significant differences in the mean changes of laboratory parameters between CAN/AML and OLM/AZ users. Our findings suggested that the effects of CAN/AML and OLM/AZ on laboratory parameters, including an unfavorable effect on renal function, were similar at least during 1 year of administration.
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Affiliation(s)
- Norio Susa
- a Division of Genomic Epidemiology and Clinical Trials , Clinical Trials Research Center, Nihon University School of Medicine , Tokyo , Japan
| | - Yayoi Nishida
- a Division of Genomic Epidemiology and Clinical Trials , Clinical Trials Research Center, Nihon University School of Medicine , Tokyo , Japan
| | - Yoichi Yada
- b Division of Pharmacology , Department of Biomedical Sciences, Nihon University School of Medicine , Tokyo , Japan
| | - Tomohiro Nakayama
- c Division of Laboratory Medicine , Department of Pathology and Microbiology, Nihon University School of Medicine , Tokyo , Japan , and.,d Division of Companion Diagnosis , Department of Pathology of Microbiology, Nihon University School of Medicine , Tokyo , Japan
| | - Satoshi Asai
- b Division of Pharmacology , Department of Biomedical Sciences, Nihon University School of Medicine , Tokyo , Japan
| | - Yasuo Takahashi
- a Division of Genomic Epidemiology and Clinical Trials , Clinical Trials Research Center, Nihon University School of Medicine , Tokyo , Japan .,d Division of Companion Diagnosis , Department of Pathology of Microbiology, Nihon University School of Medicine , Tokyo , Japan
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16
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Mohan JC, Jain R, Chamle V, Bhargava A. Short Term Safety and Tolerability of a Fixed Dose Combination of Olmesartan, Amlodipine and Hydrochlorothiazide. J Clin Diagn Res 2015; 9:OC10-3. [PMID: 26435982 DOI: 10.7860/jcdr/2015/14054.6366] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 07/14/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess the short term safety and tolerability of a fixed dose combination (FDC) of olmesartan, amlodipine and hydrochlorothiazide (OAH) in real-world clinical setting in India. MATERIALS AND METHODS Physicians were requested to provide eight weeks observational clinical event data of the patients prescribed with FDC of Olmesartan (20/40mg), Amlodipine (5mg) and hydrochlorothiazide (12.5mg) in the prescription event monitoring (PEM) forms. Data on patients' demographics, indication for FDC, concomitant medication and other relevant history was also collected and was analysed with descriptive statistics. RESULTS Two hundred thirty eight physicians provided data of 4763 patients. Mean age of the population was 55±7 years and males were 59.3%. The commonest indication for the FDC was uncontrolled hypertension (60.7%). Diabetes and dyslipidemia were present in 37.9% and 35.1% respectively. Concomitant medications included statins (42.3%), oral anti-diabetic (33.7%) and antiplatelet agents (24.7%). Pedal oedema (0.29%) was the most common adverse event (AE) reported followed by headache (0.16%), giddiness (0.15%), light headedness (0.15) and stroke (0.15%). Other less common (0.04%) reported AEs were tiredness, dizziness, gastritis, hypersomnia, hypoglycaemia, lower respiratory tract infection (LRTI), weakness, diarrhea, labyrinthitis, urinary tract infection, hyponatremia and hypotension. Occurrence of AEs was more common in patients with uncontrolled hypertension (60.74%). CONCLUSION The FDC of olmesartan, amlodipine and hydrochlorothiazide prescribed most frequently for patients with uncontrolled hypertension and co-morbidities was found to be safe and well tolerated over a short period of observation.
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Affiliation(s)
- J C Mohan
- Director, Department of Cardiology, Fortis Hospital , New Delhi, India
| | - Rishi Jain
- Deputy General Manager, Department of Medical Services, Glenmark Pharmaceuticals , Mumbai, India
| | - Vijay Chamle
- Assistant Manager, Department of Medical Services, Glenmark Pharmaceuticals , Mumbai, India
| | - Amit Bhargava
- Head, Department of Medical Services, Glenmark Pharmaceuticals , Mumbai, India
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Jung HW, Kim KI, Park CG, Kang DH, Ahn Y, Bae JH, Kim CH. A multicenter, non-comparative study to evaluate the efficacy and safety of fixed-dose olmesartan/amlodipine in Korean patients with hypertension who are naïve or non-responders to anti-hypertensive monotherapy (ACE-HY study). Clin Exp Hypertens 2015; 37:482-9. [DOI: 10.3109/10641963.2015.1013119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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18
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Jakimska A, Śliwka-Kaszyńska M, Nagórski P, Namieśnik J, Kot-Wasik A. Phototransformation of amlodipine: degradation kinetics and identification of its photoproducts. PLoS One 2014; 9:e109206. [PMID: 25279815 PMCID: PMC4184881 DOI: 10.1371/journal.pone.0109206] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 09/10/2014] [Indexed: 01/01/2023] Open
Abstract
Nowadays, monitoring focuses on the primary compounds and does not include degradation products formed during various biological and chemical processes. Transformation products may have the same effects to human health and the environment or sometimes they can be more toxic than the parent compound. Unfortunately, knowledge about the formation of degradation products is still limited, however, can be very important for the environmental risk assessment. Firstly, the photodegradation kinetic of amlodipine was investigated in two experimental conditions: during the exposure to solar radiation and during the exposure to the light emitted by the xenon lamp. In all cases degradation of amlodipine followed a pseudo-first-order kinetics. In the next step, identification of transformation products of amlodipine formed during the exposure to xenon lamp irradiation was performed using ultra high performance liquid chromatography quadrupole time-of-flight mass spectrometry (UHPLC-QTOF-MS). As a result sixteen photoproducts were identified, their structures were elucidated and ultimately the transformation pathway was proposed. Fifteen compounds (out of 16 photoproducts) were newly identified and reported here for the first time; some of those compounds were formed from the first photoproduct, amlodipine pyridine derivative. Several analytes were formed only in acidic or basic conditions. Furthermore, the occurrence of amlodipine and its identified degradation products was investigated in environmental waters. Only one out of 16 compounds was found in wastewater effluent. The possibility of the sorption of examined analytes to sewage sludge particles was discussed based on QSAR.
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Affiliation(s)
- Anna Jakimska
- Department of Analytical Chemistry, Faculty of Chemistry, Gdańsk University of Technology, Gdańsk, Poland
| | | | - Piotr Nagórski
- Department of Analytical Chemistry, Faculty of Chemistry, Gdańsk University of Technology, Gdańsk, Poland
| | - Jacek Namieśnik
- Department of Analytical Chemistry, Faculty of Chemistry, Gdańsk University of Technology, Gdańsk, Poland
| | - Agata Kot-Wasik
- Department of Analytical Chemistry, Faculty of Chemistry, Gdańsk University of Technology, Gdańsk, Poland
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19
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Rozza F, Trimarco V, Izzo R, Santoro M, Manzi MV, Marino M, Di Renzo G, Trimarco B. Antihypertensive Response to Combination of Olmesartan and Amlodipine Does Not Depend on Method and Time of Drug Administration. High Blood Press Cardiovasc Prev 2013; 20:25-32. [DOI: 10.1007/s40292-013-0013-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 12/28/2012] [Indexed: 11/24/2022] Open
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20
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Chen X, Hu P, Jiang J, Liu T, Zhong W, Liu H, Zhao Q. Pharmacokinetic and pharmacodynamic profiles of a fixed-dose combination of olmesartan medoxomil and amlodipine in healthy Chinese males and females. Clin Drug Investig 2013; 32:783-90. [PMID: 23160920 DOI: 10.1007/s40261-012-0026-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study investigated the pharmacokinetics and pharmacodynamics of a fixed-dose combination (FDC) tablet of olmesartan medoxomil 20 mg and amlodipine 5 mg (CS-8663) in healthy Chinese subjects. METHODS This single-centre, open-label study was conducted in five healthy males and five females aged 18-45 years. Subjects received a single oral dose of an olmesartan medoxomil/amlodipine 20 mg/5 mg tablet on Day 1 under fasting conditions, and after a wash-out period they received the same dose once daily from Day 15 to Day 24. Serial blood samples were collected at predefined time-points to measure the plasma concentrations of olmesartan and amlodipine during the single-dose and the multiple-dose period. Meanwhile, blood pressure and heart rate were repeatedly taken to delineate the pharmacodynamic profiles. Safety was assessed throughout the study. RESULTS After oral administration, the peak concentrations of olmesartan and amlodipine were reached in a median time of 2 and 6 h, respectively. The elimination half-life of amlodipine is more than twice as long as that of olmesartan. Steady states of both compounds were attained after once-daily dosing for 8 days. Similar significant reductions of systolic and diastolic blood pressure were observed after a single dose of an olmesartan medoxomil/amlodipine 20 mg/5 mg FDC tablet. In comparison, multiple doses of olmesartan medoxomil/amlodipine 20 mg/5 mg tablets lowered the daily pre-dose BP level and led to smaller BP changes after the last dose. Heart rate increments were larger and more sustained after multiple doses than during the single-dose period. Females showed more systolic BP reductions than males despite inter-sex similarity in pharmacokinetics. Treatment with olmesartan medoxomil/amlodipine 20 mg/5 mg FDC tablets was safe and well tolerated. CONCLUSION After single and multiple doses of olmesartan medoxomil/amlodipine 20 mg/5 mg FDC tablets the pharmacokinetic profiles of olmesartan or amlodipine were comparable to those reported for monotherapy with olmesartan medoxomil or amlodipine, except that the elimination half-life of olmesartan was longer because of the longer time course over which pharmacokinetic blood sampling was carried out in this study. The response profiles of BP indicate a concentration-dependent antihypertensive effect of the olmesartan medoxomil/amlodipine 20 mg/5 mg FDC tablet after a single dose and stabilization of such effects after multiple doses.
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Affiliation(s)
- Xia Chen
- Phase I Unit, Clinical Pharmacology Research Center, Peking Union Medical College Hospital, Xi Cheng District, Beijing, People's Republic of China
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21
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Olmesartán con diuréticos o con antagonistas del calcio: ¿a qué perfil de paciente hipertenso? HIPERTENSION Y RIESGO VASCULAR 2013. [DOI: 10.1016/s1889-1837(13)70015-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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22
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Nistala R, Sowers JR. Hypertension: Synergy of antihypertensives in elderly patients with CKD. Nat Rev Nephrol 2012. [PMID: 23183840 DOI: 10.1038/nrneph.2012.264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ravi Nistala
- Diabetes and Cardiovascular Center, University of Missouri School of Medicine, One Hospital Drive, Columbia, MO 65212, USA
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23
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Derosa G, Cicero AFG, Carbone A, Querci F, Fogari E, D'Angelo A, Maffioli P. Olmesartan/amlodipine combination versus olmesartan or amlodipine monotherapies on blood pressure and insulin resistance in a sample of hypertensive patients. Clin Exp Hypertens 2012; 35:301-7. [PMID: 22954201 DOI: 10.3109/10641963.2012.721841] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Despite the wide range of antihypertensive medications, about 45.5% of treated patients fail to achieve the desired blood pressure (BP) target. This study evaluated the effects of an olmesartan/amlodipine single pill combination compared to olmesartan or amlodipine monotherapies on BP, lipid profile, insulin resistance, and insulin sensitivity parameters. Two hundred and seventy-six patients were randomly assigned to olmesartan (20 mg), amlodipine (10 mg), or a single pill containing olmesartan/amlodipine (5/20 mg) for 12 months. We evaluated the following parameters at the baseline, and after 6 and 12 months: body weight, body mass index (BMI), systolic and diastolic blood pressure (SBP and DBP), fasting plasma glucose (FPG), fasting plasma insulin (FPI), and lipid profile. At the baseline, and after 6 and 12 months, patients underwent an euglycemic, hyperinsulinemic clamp to assess M value. Olmesartan/amlodipine gave a greater decrease in SBP and DPB compared to amlodipine and olmesartan at 6 (P < .05) and 12 months (P < .01). There was a decrease in FPG with olmesartan/amlodipine after 12 months compared to amlodipine (P < .05). Olmesartan/amlodipine decreased FPI and homeostasis model assessment index compared to both baseline (P < .05) and olmesartan and amlodipine (P < .05). Olmesartan/amlodipine gave an increase in M value, compared to baseline (P < .01) and to olmesartan monotherapy (P < .05) and amlodipine monotherapy (P < .01). In this randomized, double-blind clinical trial, olmesartan/amlodipine combination resulted more effective than olmesartan and amlodipine monotherapies in reducing BP, in improving insulin resistance, and insulin sensitivity parameters in patients with stage I essential hypertension. The combination also resulted in less peripheral edema.
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Affiliation(s)
- Giuseppe Derosa
- Department of Internal Medicine and Therapeutics, University of Pavia, Piazzale C. Golgi 2, Pavia, Italy.
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24
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Sharma AM, Bakris G, Neutel JM, Littlejohn TW, Kobe M, Ting N, Ley L. Single-pill combination of telmisartan/amlodipine versus amlodipine monotherapy in diabetic hypertensive patients: an 8-week randomized, parallel-group, double-blind trial. Clin Ther 2012; 34:537-51. [PMID: 22386829 DOI: 10.1016/j.clinthera.2012.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 02/03/2012] [Accepted: 02/03/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND Hypertensive patients with diabetes often require combination therapy to achieve a blood pressure (BP) goal, and evidence suggests that time to BP goal is crucial to decrease cardiovascular risk. OBJECTIVE The aim of the study was to investigate whether the single-pill combination of telmisartan and amlodipine was superior to amlodipine alone as initial antihypertensive therapy in patients with diabetes and hypertension. METHODS An 8-week, randomized, parallel-group, double-blind international trial comparing the once-daily single-pill combination of telmisartan 80 mg and amlodipine 10 mg (T/A; n = 352) with once-daily amlodipine 10 mg (A; n = 354) in patients with type 2 diabetes mellitus and stage 1 or 2 hypertension (systolic BP [SBP] >150 mm Hg). RESULTS Patient demographics were similar between treatment groups, with an mean (SD) age of 60.5 (10.1) years; 51.7% were male, the mean (SD) body mass index was 32.0 (6.1) and the mean (SD) duration of hypertension was 8.8 (7.9) years. After 8 weeks (primary end point) as well as after 1, 2, and 4 weeks (key secondary end points), significantly greater decreases in the in-clinic mean seated trough cuff SBP with T/A versus A were achieved (-29.0 mm Hg vs -22.9 mm Hg at 8 weeks; P < 0.0001). After 8 weeks, 71.4% versus 53.8% of patients achieved the BP goal (<140/90 mm Hg) with T/A versus A, with mean SBPs of 131.9 and 137.9 mm Hg, respectively. Similar results were observed in the obese (metabolic syndrome) subpopulation. The more stringent goal (<130/80 mm Hg) was achieved by 36.4% and 17.9% patients in the T/A and A groups, respectively. The most common adverse events were peripheral edema, headache, and dizziness. CONCLUSIONS In this selected population of patients with diabetes and hypertension, T/A provided prompt and greater BP decreases compared with A monotherapy, with the majority of patients achieving the BP goal (<140/90 mm Hg).
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Affiliation(s)
- Arya M Sharma
- Chair for Obesity Research & Management, University of Alberta, Royal Alexandra Hospital, Edmonton, Alberta, Canada.
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