BackgroundAngiotensin II type 1 receptor blockers (ARB) are a frequently used class of antihypertensive drug. The ARB losartan is known to decrease the serum uric acid (SUA) level. However, there are very few clinical data comparing the effects of other ARBs on SUA level under the conditions of clinical practice. This study evaluated and compared the long-term effects of monotherapy with five ARBs on SUA level in Japanese hypertensive patients with type 2 diabetes mellitus (DM).MethodsWe identified hypertensive patients with type 2 DM who had been treated with monotherapy with losartan (n = 214), valsartan (n = 266), telmisartan (n = 185), candesartan (n = 458), or olmesartan (n = 192), in whom laboratory data of SUA between November 1, 2004 and July 31, 2011 were available, from the Nihon University School of Medicine’s Clinical Data Warehouse (NUSM’s CDW). We used a propensity-score weighting method and a multivariate regression model to adjust for differences in the background among ARB users, and compared the SUA level. The mean exposure of losartan was 264.7 days, valsartan 245.3 days, telmisartan 235.9 days, candesartan 248.9 days, and olmesartan 234.5 days.ResultsIn losartan users, mean SUA level was significantly decreased from baseline, while it was conversely increased in users of other ARBs; valsartan, telmisartan, candesartan, and olmesartan. The mean reduction of SUA level from baseline was significantly greater in losartan users compared with that in other ARB users. Comparison of ARBs other than losartan showed no significant difference in mean change in SUA level from baseline.ConclusionsOur study showed that losartan had the most beneficial effect on SUA level among five ARBs, and that there was no significant difference in the unfavorable effects on SUA level among four ARBs other than losartan, at least during one year. These findings provide evidence of an effect of ARBs on SUA level, and support the benefit of the use of losartan in hypertensive patients with type 2 DM.

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.

Aims:To survey the changes in serum lipid profiles in patients with hypertension up to 12 months, and to investigate correlations between these values and the time after the start of olmesartan monotherapy.Methods: We retrospectively examined longitudinal changes in serum lipid profiles in patients with mild to moderate hypertension that had been newly treated with olmesartan monotherapy. Data from 139, 150, 185 and 188 patients were obtained for high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglyceride (TG) and total cholesterol (TC) levels, respectively, from the Clinical Data Warehouse of Nihon University School of Medicine. Generalized estimating equations and generalized linear mixed model with an inverse probability of treatment weighting method were used to analyze the relationships between these longitudinal blood examination data and explanatory variables of patient sex, age, diagnosis of diabetes mellitus (DM) and duration of olmesartan monotherapy.Results: Serum HDL-C and TC levels were associated with sex, but not with age, diagnosis of DM or duration of treatment. TG level was associated with the diagnosis of DM, but not with sex, age or treatment duration. LDL-C level was not associated with any of the explanatory variables. Subgroup analysis of the subjects divided by diagnosis of DM revealed a decrease in TC level in non-DM subjects (p = 0.0284), but not in DM subjects. Dunnett's multiple-comparison test showed that none of the lipid parameters were changed significantly compared with baseline at any time point.Conclusions: Our study revealed that HDL-C, LDL-C, TG and TC levels were not influenced by olmesartan monotherapy up to 12 months. With respect to lipid metabolism, olmesartan may be used safely for patients with hypertension, because the effect on lipids may be negligible.