Olmesartan/amlodipine vs olmesartan/hydrochlorothiazide in hypertensive patients with metabolic syndrome: the OLAS study

Abstract

We studied the effects of treatment with olmesartan/amlodipine and olmesartan/hydrochlorothiazide on inflammatory and metabolic parameters (including new-onset diabetes as a secondary endpoint) in non-diabetic hypertensive patients with metabolic syndrome (MetS). A total of 120 patients with MetS and stage I and II hypertension were randomized to olmesartan 20 mg/amlodipine 5 mg or olmesartan 20 mg/hydrochlorothiazide 12.5 mg. If target systolic blood pressure (<140 mm Hg) was not reached, doses were doubled after 13 weeks; doxazosin 4 mg was added after 26 weeks, and doubled after 39 weeks; follow-up ended at 78 weeks. At each visit, blood pressure (BP), fasting plasma glucose, insulin, adiponectin, tumour necrosis factor-α, C-reactive protein (CRP), intercellular adhesion molecule-1, vascular cell adhesion molecule-1, interleukins-1β, -6 and -8, and albuminuria were measured; BP was similarly reduced in both groups; 80% of patients reached target BP. Reductions in albuminuria were also similar (50%). Only olmesartan/amlodipine reduced the insulin resistance index (24%, P<0.01), increased plasma adiponectin (16%, P<0.05) and significantly reduced all of the inflammation markers studied, except CRP, which showed a similar reduction in each group. The risk of new-onset diabetes was significantly lower with olmesartan/amlodipine (P=0.02). Both olmesartan-based combinations were effective, but the amlodipine combination resulted in metabolic and anti-inflammatory effects that may have advantages over the hydrochlorothiazide combination.

The effects of angiotensin receptor blockers vs. calcium channel blockers on the acute exercise-induced inflammatory and thrombotic response

“…The anti-inflammatory effects of ARBs in hypertensive patients with microinflammation have been previously reported in the EUTOPIA study; olmesartan significantly reduced resting levels of hsCRP ( À15.1%, Po0.05), TNF-a ( À8.9%, Po0.02) and IL-6 ( À14.0%, Po0.05) within 6 weeks of treatment. 26 Similar findings for dihydropyridines have been reported in hypertensive patients with metabolic syndrome (MARCADOR and OLAS studies), 23,24 whereas there are no respective reports for non-dihydropyridines. Furthermore, perindopril has shown to have beneficial effects on inflammation indicators during exercise in patients with metabolic syndrome.…”

“…12,14,16 Antihypertensive treatment has been associated with beneficial effects on subclinical inflammation and thrombosis at rest and during exercise. [22][23][24][25][26] Nevertheless, comparative studies between different BPlowering agents have not been previously reported.…”

The ‘pyrrhic victory’ of amlodipine over hydrochlorothiazide in the OLAS Study

“…We read with interest the well-written article by Martinez-Martin et al 1 entitled 'olmesartan/ amlodipine versus olmesartan/hydrochlorothiazide in hypertensive patients with metabolic syndrome: the OLAS Study'. The authors by using a parallel group, prospective open-label, blinded end-point design, have elegantly shown that both olmesartan combinations were well tolerated, effective in reducing blood pressure and additionally demonstrated benefit for different cardiorenal risk markers.…”

Distinct effects of fixed combinations of valsartan with either amlodipine or hydrochlorothiazide on lipoprotein subfraction profile in patients with hypertension

“…3 In this context, many preclinical and small clinical studies with surrogate end points suggested that several antihypertensive drug categories, especially ARBs, angiotensin-converting enzyme inhibitors and calcium channel blockers may have benefits 'beyond BP control'. 7,8 The identification of such properties could help the selection of an optimal combination of antihypertensive drugs.…”