Olmesartan vs ramipril in the treatment of hypertension and associated clinical conditions in the elderly: a reanalysis of two large double-blind, randomized studies at the light of the most recent blood pressure targets recommended by guidelines

Abstract

In this paper, we present the results of a reanalysis of the data of two large randomized, double-blind, parallel group studies with a similar design, comparing the efficacy of an angiotensin-receptor blocker (olmesartan medoxomil) with that of an angiotensin-converting enzyme inhibitor (ramipril), by applying two different blood pressure targets recently recommended by hypertension guidelines for all patients, irrespective of the presence of diabetes (<140/90 mmHg), and for elderly hypertensive patients (<150/90 mmHg). The efficacy of olmesartan was not negatively affected by age, sex, hypertension type, diabetes status or other concomitant clinical conditions, or cardiovascular risk factors. In most cases, olmesartan provided better blood pressure control than ramipril. Olmesartan was significantly more effective than ramipril in male patients, in younger patients (aged 65-69 years), in those with metabolic syndrome, obesity, dyslipidemia, preserved renal function, diastolic ± systolic hypertension, and, in general, in patients with a high or very high cardiovascular risk. Interestingly, patients previously untreated or treated with two or more antihypertensive drugs showed a significantly larger response with olmesartan than with ramipril. Thus, our results confirm the good efficacy of olmesartan in elderly hypertensives even when new blood pressure targets for antihypertensive treatment are considered. Such results may be relevant for the clinical practice, providing some hint on the possible different response of elderly hypertensive patients to two different drugs acting on the renin-angiotensin system, when patients are targeted according to the blood pressure levels recommended by recent hypertension guidelines.

Keywords: arterial hypertension; elderly; guidelines; olmesartan medoxomil; ramipril.

Figure 1

Percentage of normalized patients according to different thresholds. Notes: (A) Original study thresholds, <140/90 mmHg in nondiabetics and <130/80 mmHg in diabetics. (B) <140/90 mmHg for all patients. (C) <150/90 mmHg for all patients after 2, 6, and 12 weeks of treatment with olmesartan 10–40 mg (white bars) or ramipril 2.5–10 mg (black bars). P-values for between-treatment difference are also reported.

Figure 2

Percentage of normalized patients. Notes: (A) <140/90 mmHg. (B) <150/90 mmHg after 12 weeks of treatment with olmesartan 10–40 mg (white bars) or ramipril 2.5–10 mg (black bars) according to the presence of specific metabolic abnormalities. P-values for between-treatment difference are also reported.

Figure 3

Percentage of normalized patients. Notes: (A) <140/90 mmHg. (B) <150/90 mmHg after 12 weeks of treatment with olmesartan 10–40 mg (open square) or ramipril 2.5–10 mg (full square) according to estimated glomerular filtration rate (eGFR). P-values for between-treatment difference are also reported.

Figure 4

Percentage of normalized patients. Notes: (A) <140/90 mmHg. (B) <150/90 mmHg after 12 weeks of treatment with olmesartan 10–40 mg (white bars) or ramipril 2.5–10 mg (black bars) according to the number and type of previous antihypertensive drugs. P-values for between-treatment difference are also reported. Abbreviations: ACE, angiotensin-converting enzyme; ARB, angiotensin-receptor blocker.