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Meta-Analysis
. 2018 Feb;20(2):356-365.
doi: 10.1111/jch.13183.

Comparative effectiveness of an angiotensin receptor blocker, olmesartan medoxomil, in older hypertensive patients

Josep Redon  1   2 , Michael A Weber  3 , Paul-Egbert Reimitz  4 , Ji-Guang Wang  5
Affiliations
Meta-Analysis

Comparative effectiveness of an angiotensin receptor blocker, olmesartan medoxomil, in older hypertensive patients

Josep Redon et al. J Clin Hypertens (Greenwich). 2018 Feb.

Abstract

The efficacy and safety of olmesartan medoxomil (OM) vs active control (AC) monotherapy among elderly patients aged 60-79 years (N = 4487) was evaluated by meta-analysis (25 studies). In all patients, change from baseline to end point in blood pressure (BP) was significantly greater with OM vs AC (-19.5/-11.9 vs -16.8/-10.7 mm Hg). Greater proportions of OM- vs AC-treated patients achieved BP goals. In patients with impaired renal function (estimated glomerular filtration rate <60 mL/min/1.73 m2 ), OM treatment resulted in a greater mean change from baseline in systolic BP vs AC (-21.2 vs -18.7 mm Hg, respectively) and a greater proportion of patients achieving BP goals. These parameters were similar in both groups for elderly patients with diabetes. OM was well tolerated with few adverse events. OM monotherapy can be used as an initial treatment for hypertension in elderly patients, including those with renal impairment or diabetes.

Keywords: elderly; hypertension; olmesartan medoxomil.

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Conflict of interest statement

JR is an advisory board member and lecturer for Boehringer Ingelheim, Daiichi Sankyo, and Menarini International and is a lecturer for Novartis. MAW has served as a consultant for Allergan, Daiichi Sankyo, and Novartis and as a speaker for Menarini and Merck Sharp & Dohme. P‐ER is an employee of Daiichi Sankyo. J‐GW reports receiving research grants from Bayer and Pfizer and lecture and consulting fees from Bayer, Daiichi Sankyo, Merck Sharp & Dohme, Novartis, Pfizer, Sanofi, and Servier.

Figures

Figure 1
Figure 1
Effect of drug treatment on the elderly patient population in the full analysis set. (A) Mean SeSBP over time; (B) mean SeDBP over time; changes from baseline in mean (C) SeSBP and (D) SeDBP over time; achievement of (E) SeBP <140/90 mm Hg and (F) SeSBP <140 mm Hg from baseline through study end point (LOCF). aP  = .0011 for OM vs AC based on Cochran‐Mantel‐Haenszel test. bP  = .0004 for OM vs AC based on Cochran‐Mantel‐Haenszel test. AC, active control; EP, end point; LOCF, last observation carried forward; OM, olmesartan medoxomil; SeBP, seated blood pressure; SeDBP, seated diastolic blood pressure; SeSBP, seated systolic blood pressure
Figure 2
Figure 2
Two‐way analysis of covariance of absolute change on mean seated systolic blood‐pressure from baseline to end point in the full analysis set (wk 12, last observation carried forward). For the estimated treatment difference (all studies), the exploratory P value is .023 and heterogeneity values are Q = 47.138, P = .003, and I 2 = 49.086. AC, active control; ACEi, angiotensin‐converting enzyme inhibitor; ARB, angiotensin II receptor blocker; CCB, calcium channel blocker; CI, confidence interval; LCL, lower confidence limit; LSM, least‐squares mean; OM, olmesartan medoxomil; UCL, upper confidence limit
Figure 3
Figure 3
Effect of drug treatment on the elderly patient population with an estimated glomerular filtration rate <60 mL/min/1.73 m2. (A) Mean SeSBP over time; (B) change from baseline in mean SeSBP over time; achievement of (C) SeBP <140/90 mm Hg and (D) SeSBP <140 mm Hg from baseline through study end point (LOCF). aP  = .2301 for OM vs AC based on Cochran‐Mantel‐Haenszel test. bP  = .2470 for OM vs AC based on Cochran‐Mantel‐Haenszel test. AC, active control; EP, end point; LOCF, last observation carried forward; OM, olmesartan medoxomil; SeBP, seated blood pressure; SeSBP, seated systolic blood pressure
Figure 4
Figure 4
Effect of drug treatment on the elderly patient population with diabetes. (A) Mean SeSBP over time; (B) change from baseline in mean SeSBP over time; achievement of (C) SeBP <140/90 mm Hg and (D) SeSBP <140 mm Hg from baseline through study end point (LOCF). aP  = .4478 for OM vs AC based on Cochran‐Mantel‐Haenszel test. bP  = .5853 for OM vs AC based on Cochran‐Mantel‐Haenszel test. AC, active control; EP, end point; LOCF, last observation carried forward; OM, olmesartan medoxomil; SeBP, seated blood pressure; SeSBP, seated systolic blood pressure
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