Effect of the angiotensin II receptor antagonist olmesartan on morning home blood pressure in hypertension: HONEST Study at 16 weeks

Abstract

Morning home blood pressure (BP) levels are more closely associated with cardiovascular risk than clinic BP levels. However, control of morning home BP has been worse than that of clinic BP in clinical practice. We examined the effects of olmesartan-based treatment using data (n=21 341) from the first 16 weeks of the Home BP measurement with Olmesartan Naive patients to Establish Standard Target blood pressure (HONEST) study, a prospective observational study for olmesartan-naive patients with essential hypertension. After 16-week olmesartan-based treatment, the clinic and morning home systolic BP (SBP) lowered from 151.6±16.4 and 153.6±19.0 mm Hg to 135.0±13.7 and 135.5±13.7 mm Hg, respectively (P<0.0001). The achievement percentage of target morning home SBP (<135 mm Hg) in all patients, those with diabetes mellitus (DM), and those with chronic kidney disease (CKD) increased from 13.5, 16.4 and 17.2% to 50.8, 47.9 and 48.8%, respectively, and the proportion of patients with well-controlled hypertension (clinic SBP<140 mm Hg and morning home SBP<135 mm Hg) increased from 7.9, 9.2 and 10.2% to 38.9, 34.5 and 36.3%, respectively. After 16-week olmesartan-based treatment, the proportion of patients with masked and white coat hypertension changed from 11.8 to 24.2% and 5.6 to 11.9%. In conclusion, both clinic and morning home BP in all, DM and CKD patients improved with 16-week olmesartan-based treatment in the ‘real world', and the results showed a sustained 24-hour BP-lowering effect of olmesartan. Decrease in clinic and home BP resulted in an increased rate of masked and white coat hypertension, and further management is needed in those patients.

Increased cardiovascular risk of treated white coat and masked hypertension in patients with diabetes and chronic kidney disease: the HONEST Study

“…8 In our previous article describing the findings of the HONEST study, we reported a decrease in the proportion of patients with poorly controlled hypertension (PCH), that is, patients whose HBP and CBP were both high, and a consequent increase in the proportion of patients with WCH or MH after treatment with olmesartan. 9 After 16 weeks, the numbers of patients in both the WCH group and the MH group were approximately double the numbers at baseline. 9, 10 …”

“…9 After 16 weeks, the numbers of patients in both the WCH group and the MH group were approximately double the numbers at baseline. 9, 10 …”

Problems in Pharmacotherapy of Resistant Arterial Hypertension

“…В исследовании HONEST олмесартана у наивных пациентов с артериальной гипертензией особое внимание уделялось отношению АД на визите к врачу и при самостоятельном измерении. Kario et al (2013) были проанализированы данные 21341 пациента в проспективном наблюдении на протяже-нии 16 недель. Пациенты контролировали АД само-стоятельно по утрам и во время визитов к врачу.…”

“…Эти данные, по мнению авторов, не только свидетельствуют об эффективно-сти олмесартана, но и обращают внимание на важ-ность разностороннего контроля АД, так как при лечении и нормализации АД происходит повыше-ние частоты гипертензии "белого халата", что может сказываться на общем качестве лечения. Авторы подчёркивают, что "в реальном мире" олмесартан способствует эффективному контролю АД, в том числе, при сахарном диабете и хронической болезни почек [20].…”

The effect of continuous positive airway pressure therapy on the prevalence of masked hypertension in obstructive sleep apnea patients

“…According to the available literature only one small sample size study of CPAP effects on the prevalence of MH has been published 15 . Kario et al 23 considered masked hypertension as a first step toward correct blood pressure compensation. If we assume that CPAP improves blood pressure, it should also reduce masked hypertension.…”