Differential Effects in Cardiovascular Markers between High-Dose Angiotensin II Receptor Blocker Monotherapy and Combination Therapy of ARB with Calcium Channel Blocker in Hypertension (DEAR Trial)

Abstract

Background/Aims. Arterial stiffness is an independent risk factor for cardiovascular morbidity and mortality. This study was conducted to determine the effect of olmesartan (OLM) and azelnidipine (AZL) on arterial stiffness using the cardio-ankle vascular index (CAVI), which is a novel blood pressure (BP)-independent marker for arterial stiffness in hypertensive patients. Methods. Fifty-two consecutive hypertensive patients were randomly assigned either to a group treated with OLM monotherapy or to a group treated with OLM and AZL combination therapy. Clinical and biological parameters were measured before and 12 months after the start of this study. Results. Both therapies significantly and similarly reduced BP, augmentation index, and plasma aldosterone levels. The combination therapy significantly decreased CAVI and serum low-density lipoprotein (LDL-C) levels and these reductions were significantly greater than those produced with monotherapy. No significant differences in metabolic parameters were observed between the two therapies. Conclusion. The combination therapy with OLM and AZL had beneficial effects on arterial stiffness assessed by CAVI, LDL-C, and metabolism, despite the similar BP reduction, compared with OLM monotherapy. Since these markers are known to influence the future risk of cardiovascular events, combination therapy with OLM and AZL could be a useful choice for treating hypertensive patients.

The Effects of Antihypertensive Agents in Metabolic Syndrome – Benefits Beyond Blood Pressure Control

“…Arterial stiffness, measured through cardioankle vascular index was significantly decreased with combination of olmesartan and azelnidipine, but not with olmesartan monotheraphy [101]. However, arterial index decreased significantly with monotheraphy and combination therapy in this study.…”

A Low Fixed-dose Combination of Olmesartan and Azelnidipine Significantly Improves Endothelial Function in Uncontrolled Hypertension by Low Dose Amlodipine

“…The present study results agree with previously reported observations in human studies. 4,8,[15][16][17] The combination azelnidipine and olmesartan therapy showed an anti-oxidant stress effect and reduced albuminuria in hypertensive diabetic patients with chronic kidney disease significantly more than other antihypertensive therapy. 15) In addition, the combination of azelnidipine and olmesartan decreased arterial stiffness assessed using the cardio-ankle vascular index in hypertensive patients.…”

“…15) In addition, the combination of azelnidipine and olmesartan decreased arterial stiffness assessed using the cardio-ankle vascular index in hypertensive patients. 8) Another study demonstrated that olmesartan with azelnidipine therapy had greater effects on central BP and left ventricular mass index than did olmesartan and amlodipine combination treatment, even though the reduction in brachial BP was similar in both groups. 16) This study suggests that the superior effects of the hour BP variability are connected with the changes in FMD and NMD in the brachial artery.…”

“…6) In another report, this combination significantly ameliorated vascular endothelial function assessed by acetylcholine stimulation. 7) In human studies, 8) combination therapy with azelnidipine and olmesartan significantly improved aortic pulse wave velocity and Background: Flow-mediated dilation (FMD) and nitroglycerin-induced dilation (NMD) in the brachial artery are well-known indices for evaluating endothelial function (ECF). The fixed-dose combination of olmesartan, an angiotensin receptor blocker (ARB, 10 mg), and azelnidipine (Ca-channel blocker; CCB, 8 mg: ARB-CCB) might effectively lower blood pressure in patients with uncontrolled hypertension and possibly ameliorate ECF.…”