SummaryMany patients still have high blood pressure (BP) after treatment with angiotensin II type 1 (AT 1 ) receptor blockers (ARBs). We compared the efficacy and safety of azilsartan to those of olmesartan in a prospective randomized clinical trial. Sixty-four hypertensive patients who were treated with ARBs other than azilsartan and olmesartan were enrolled in this study. We randomly assigned patients to changeover from their prior ARBs to either azilsartan or olmesartan, and followed the patients for 3 months. Systolic BP (SBP) in the azilsartan group was significantly decreased at 3 months, and diastolic BP (DBP) and pulse rate (PR) in the olmesartan group showed significant reductions after 3 months. There were no significant differences in ΔSBP, ΔDBP, or ΔPR (Δ = the value at 3 months minus the value at 0 months) between the groups. Serum levels of creatinine (Cr), uric acid (UA), and potassium (K) in the azilsartan group significantly increased after 3 months. While the changes in Cr, UA, and K were within the respective normal ranges, ΔSBP was positively associated with ΔCr in the azilsartan group. In conclusion, there was no difference in the depressor effects of azilsartan and olmesartan, and there were no serious changes in biochemical parameters with azilsartan and olmesartan. (Int Heart J 2017; 58: 416-421) Key words: Blood pressure, Angiotensin II type 1 receptor blocker, Uric acid S even types of angiotensin II type 1 (AT 1 ) receptor blockers (ARBs) have been developed and are available for clinical use in Japan.1) ARBs is effective in the treatment of cardiovascular disorders, including hypertension and heart failure.1,2) ARBs have been reported to have class-specific (common) and moleculespecific (differential) effects in basic experimental studies. 3)We have proposed that small differences in the molecular structures of ARBs could lead to differences in their abilities to influence the AT 1 receptor. 3,4) Azilsartan is the newest ARB to be approved for clinical use in Japan, and has a significant blood pressure (BP)-lowering effect, although the next generation ARBs could be a significant breakthrough in the field of cardiovascular medicine. 5)Azilsartan medoxomil and azilsartan have been reported to have greater antihypertensive effects than other ARBs.6-9) Azilsartan has been shown to bind tightly to and dissociate slowly from AT 1 receptors.10) Therefore, we hypothesized that the depressor effect of azilsartan may be superior to those of other ARBs in patients with hypertension (HTN). In this study, we performed a changeover from their prior ARBs to azilsartan or olmesartan in patients with hypertension, and compared the efficacy and safety of azilsartan to those of olmesartan in a prospective randomized clinical trial. MethodsStudy design: Sixty-four hypertensive patients who were treated with ARBs except for azilsartan and olmesartan were enrolled. We applied a changeover of ARBs, where patients were prospectively and randomly switched from their prior ARBs, except for azilsartan and ...

High-dose telmisartan/HCTZ therapy was associated with a significant reduction in BP and helped patients achieve their target BP.

Objective: We analyzed the efficacy and safety of combination therapy of high-dose losartan (100 mg/day) and hydrochlorothiazide (HCTZ, 12.5 mg/day) compared with those of the combination of high-dose telmisartan (80 mg/day) and HCTZ (12.5 mg/day). Methods: Forty hypertensive patients who received a combination of high-dose telmisartan and HCTZ were enrolled. We applied a changeover strategy with switching from a combination of high-dose telmisartan and HCTZ to high-dose losartan and HCTZ. We divided the patients into two groups; those who achieved the target blood pressure (controlled group) and those who did not reach the target blood pressure (uncontrolled group) before the changeover and performed further analysis. Results: The uncontrolled group showed a significant decrease in systolic blood pressure (SBP) (143±12 mmHg to 126±11 mmHg at three months). In addition, serum uric acid significantly decreased in all subjects, and in each of the controlled and uncontrolled groups. There were no significant changes in other biochemical parameters, such as potassium and hemoglobin A1c, at three months after the changeover in all subjects. Conclusion: Combination therapy with high-dose losartan and HCTZ was superior to the combination of telmisartan and HCTZ with respect to significant decreases in systolic blood pressure and serum uric acid in hypertensive patients.

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BackgroundMany patients continue to have high blood pressure (BP) even after treatment with high-dose (H)-angiotensin II type 1 receptor blocker (ARB)/calcium channel blocker (CCB) or middle-dose (M)-ARB/CCB/hydrochlorothiazide (HCTZ).MethodsThirty-two hypertensive patients who had the use of H-ARB/CCB or M-ARB/CCB/HCTZ were enrolled in this study. We applied a changeover with a switch to H-ARB (telmisartan 80 mg/day)/CCB (amlodipine 5 mg/day or nifedipine CR 40 mg/day)/HCTZ (12.5 mg/day).ResultsSystolic BP (SBP) and diastolic BP (DBP) were significantly decreased in all patients and in the H-ARB/CCB and M-ARB/CCB/HCTZ groups after 3 months. Percentage (%) of patients who reached the target BP after 3 months (72%) in all patients was significantly higher than that at 0 months (19%). There were no serious adverse effects in any of the patients.ConclusionsCombination therapy with H-ARB/CCB/HCTZ was associated with a significant reduction of BP.