Twenty-four hour and early morning blood pressure control of olmesartan vs. ramipril in elderly hypertensive patients: pooled individual data analysis of two randomized, double-blind, parallel-group studies

Omboni S et al. – Olmesartan medoxomil provides a more effective and sustained 24–h blood pressure (BP) control than ramipril in elderly hypertensive patients, particularly in the hours farthest from last intake.

Methods

• After a 2–week placebo wash–out 1453 elderly hypertensive patients (65–89 years; sitting office DBP 90–109mmHg and/or sitting office SBP 140–179mmHg) were randomized to a 12–week double–blind treatment with olmesartan medoxomil 10mg or ramipril 2.5mg once–daily, up–titrated (20 and 40mg olmesartan medoxomil; 5 and 10mg ramipril) after 2 and 6 weeks in patients without normalized office BP. 24–h ABP was recorded at randomization and after 12 weeks.

Results

• In 715 patients with valid baseline and end–of–treatment recordings baseline–adjusted 24–h SBP and DBP reductions were greater with olmesartan medoxomil (n=356) than with ramipril (n=359) [between–treatment differences and 95% confidence interval (CI), SBP: 2.2 (3.8, 0.6), P=0.006; DBP: 1.3 (2.2, 0.3), P=0.009].
• Olmesartan medoxomil showed larger BP reductions in the last 6h from the dosing interval and higher smoothness indices than ramipril.
• Olmesartan medoxomil reduced the SBP morning rise [–2.8 (–4.9, –0.8) mmHg], whereas ramipril did not [+1.5 (–0.6, +3.6) mmHg; P=0.004 between–treatments].
• Five hundred and eighty–two patients with sustained hypertension (office and 24–h ambulatory hypertension) showed the largest antihypertensive effect, with between–treatment differences still in favor of olmesartan medoxomil [SBP: 2.1 (3.9, 0.4), P=0.019; DBP: 1.2 (2.3, 0.1), P=0.032].

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