R E V I E W Olmesar tan medoxomil combined with hydrochlorothiazide for the treatment of hyper tension Mark Greathouse South Hills Cardiology Associates of Pittsburgh, Pittsburgh, PA, USA Correspondence: Mark Greathouse South Hills Cardiology Associates of Pittsburgh, 2000 Oxford Drive, Suite 680, Bethel Park, PA 15102, USA Tel +1 412 851 0279 Fax +1 412 831 1931 Email greathouse@earthlink.net Abstract: In most patients with hypertension, especially Stage 2 hypertension, adequate control of blood pressure (BP) is only achieved with combination drug therapy. When using combination therapy, antihypertensive agents with complementary mechanisms of action are recommended, for example, an angiotensin receptor blocker (ARB) in combination with hydrochlorothiazide (HCTZ), a β-blocker + HCTZ, an ACE inhibitor + HCTZ, or a calcium channel blocker + an ACE inhibitor. One such combination is olmesartan medoxomil + HCTZ, which is available as fixed-dose, single-tablet combinations for once-daily administration. In clinical trials, olmesartan medoxomil/HCTZ reduced systolic BP (SBP) and diastolic BP (DBP) to a greater extent than either component as monotherapy. A clinical study in patients with Stage 1 or 2 hypertension showed that olmesartan medoxomil/HCTZ achieved a similar mean reduction in DBP, but a significantly greater mean reduction in SBP and higher rate of BP control (<140/90 mmHg) than observed with losartan/HCTZ, at US/European-approved starting doses. In a non-inferiority trial, the antihypertensive efficacy of olmesartan medoxomil/HCTZ was comparable to that of atenolol/HCTZ. Furthermore, indirect comparisons have shown that olmesartan medoxomil/HCTZ compares favorably with other antihypertensive combination therapies, including other ARB/HCTZ combinations and amlodipine besylate/ benazepril. Olmesartan medoxomil/HCTZ is generally well tolerated. In conclusion, olmesartan medoxomil/HCTZ is an effective and well-tolerated combination antihypertensive therapy that results in significant BP reductions and BP control in many patients. Keywords: olmesartan medoxomil, hydrochlorothiazide, angiotensin II receptor blocker, hypertension Introduction Hypertension is a highly prevalent cardiovascular risk factor, affecting an estimated 65 million people in the United States alone (American Heart Association 2006). The control of blood pressure (BP) is important for the prevention of cardiovascular morbidity and mortality; however, as many as two-thirds of patients do not have their BP adequately controlled (Chobanian et al 2003). Treatment goals recommended by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) and international guidelines are <140/90 mmHg, or <130/80 mmHg for patients with diabetes or chronic renal disease (European Society of Hypertension 2003; Chobanian 2003; Whitworth 2003) In most patients, especially those with Stage 2 hypertension (systolic BP [SBP] ≥160 mmHg or diastolic [DBP] ≥100 mmHg), combination therapy is needed to achieve adequate control of BP, and it is generally recommended that drugs with complementary mechanisms of action should be used (Chobanian et al 2003). Several fixed-dose combinations are now available, including β-blockers + hydrochlorothiazide (HCTZ), ACE inhibitors + HCTZ, angiotensin receptor blockers (ARBs) + HCTZ, and ACE inhibitors + calcium channel blockers. Many of these Vascular Health and Risk Management 2006:2(4) 401–409 © 2006 Dove Medical Press Limited. All rights reserved 401