Comparison of effects of azelnidipine and trichlormethiazide in combination with olmesartan on blood pressure and metabolic parameters in hypertensive type 2 diabetic patients

Abstract

Aims/Introduction: Angiotensin II type 1 receptor blockers (ARB) are regarded as first‐line treatment for type 2 diabetes with hypertension. However, lowering blood pressure to the target level often requires more than one antihypertensive agent as recommended by the guideline. In this open‐label, prospective, crossover clinical trial, we compared the effects of combination treatment of ARB with a calcium channel blocker (CCB) or with a low‐dose thiazide diuretic on blood pressure (BP) and various metabolic parameters in hypertensive patients with type 2 diabetes.Materials and Methods: A total of 39 Japanese type 2 diabetics with hypertension treated with olmesartan (20 mg/day) for at least 8 weeks were recruited to this study. At study entry, treatment was switched to either olmesartan (20 mg/day)/azelnidipine (16 mg/day) or olmesartan (20 mg/day)/trichlormethiazide (1 mg/day) and continued for 12 weeks. Then, the drugs were switched and treatment was continued for another 12 weeks. We measured clinical blood pressure and various metabolic parameters before and at the end of each study arm.Results: Compared with the olmesartan/trichlormethiazide treatment, treatment with olmesartan/azelnidipine achieved superior clinical blood pressure and pulse rate control. In contrast, the treatment with olmesartan/trichlormethiazide resulted in increased HbA1c, serum uric acid and worsening of estimated glomerular filtration rate, though there were no differences in other metabolic parameters including urine 8‐hydroxy‐2′‐deoxyguanosine, C‐reactive protein and adiponectin between the two treatments.Conclusions: Our results show that the combination of ARB with azelnidipine is more beneficial with regard to blood pressure control and metabolic outcome than the combination of olmesartan with low dose trichlormethiazide. This trial was registered with UMIN clinical trial registry (no. UMIN000005064). (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2011.00135.x, 2011)

Comparison of effects of pitavastatin and atorvastatin on glucose metabolism in type 2 diabetic patients with hypercholesterolemia

“…As we only recruited Japanese patients with good or moderate glycemic control, other studies that include patients with poor glycemic control, subjects at risk of diabetes or patients at high risk for cardiovascular disease are required to further evaluate the effect of pitavastatin on glycemic control. Considering practical issues related to clinical research, we did not set up a washout period based on ethical issues. The results showed no statistically significant sequence effects for all biochemical parameters listed in Tables and .…”

Effect of N- and T-type calcium channel blocker on proteinuria, blood pressure and kidney function in hypertensive patients: a meta-analysis

“…[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] Blockers of the RAAS were prescribed in both the intervention and control groups in all included studies. Characteristics of the individual trials are displayed in Table 1.…”

“…The mean age of the subjects ranged from 33 to 72 years, and the duration of follow-up ranged from 4 to 24 months. Nine studies enrolled patients with preserved kidney function (GFR460 ml min − 1 1.73 m − 2 ) 22,24,26,[28][29][30]32,33,36 and eight studies enrolled patients with low GFR (o60 ml min − 1 1.73 m − 2 ). 23,25,27,31,34,35,37,38 At enrollment, hypertension was well controlled in only 3 studies 22,28,34 and poorly controlled in the remaining 14 studies.…”

“…The GFR was assessed in 15 studies. The GFR was estimated using the Cockcroft-Gault equation in one study 34 and either the modified estimated GFR (eGFR) estimating equation developed for Japanese persons by the Japanese Society of Nephrology 39 in nine studies 26,27,[31][32][33][35][36][37][38] or the Modification of Diet in Renal Disease Study equation for Japanese patients 40 in four trials. 24,25,29,30 One study did not specify the calculation method.…”

“…28,30 Two trials did not identify the method of urine protein collection. 24,33 Seven studies enrolled only patients with microalbuminuria (30-300 mg day − 1 ). 22,26,28,29,31,32,36 Three studies enrolled patients with macroalbuminuria (4300 mg day − 1 ).…”