Efficacy and Tolerability of Combination Antihypertensive Drug in Non-Responders to ARB monoTHerapy Using 24h ABPM

Study Overview
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Brief Summary
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A majority of Korean doctors tend to add other antihypertensive rather than to titrate the same drug. However, we try to induce doctors to titrate the Sevikar than to add other antihypertensive if patients are not controlled with Sevikar 5/20mg(amlodipine 5mg + omlesartan 20mg). As above, for patients who are not controlled with Sevikar 5/20mg, doctors will proceed to other prescription pattern with other choices of titration to Sevikar 5/40, 10/40mg. It is important to evaluate BP lowering efficacy of Sevikar through the titration step in patients uncontrolled with Sevikar low dose. Thus, this study is designed to demonstrate the efficacy of Sevikar by titration in patients who are not controlled their BP with low dose of Sevikar.

Official Title
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Efficacy and Tolerability of Combination Antihypertensive Drug in Non-Responders to Angiotensin Receptor Blocker(ARB) monoTHerapy Using 24h ABPM.

Conditions
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Hypertension

Intervention / Treatment
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* Drug: SEVIKAR


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Male and female subjects > 55 years Subject who has consent to participate by signing on the informed consent form Uncontrolled hypertensive patients defined as: Uncontrolled hypertensive: subjects who are mean SBP ≥ 140 mmHg after being treated with ARB(Valsartan 80mg or Candesartan 8mg) monotherapy during at least 4 weeks. Exclusion Criteria: Secondary hypertension SeSBP ≥ 180mmHg SeSBP difference ≥ 20mmHg or SeDBP difference ≥ 10mmHg A history of hypertensive encephalopathy, unstable angina, transient ischemic attack, MI, or any type of revascularization procedure within the last 6 months Heart failure, second- or third-degree heart block, significant arrhythmia or valvular heart disease Significant cardiovascular, cerebrovascular, renal, gastrointestinal, or hematologic disease, at the discretion of investigator Creatinine clearance<20mL/min and Renal artery stenosis, Renal Transplantation, Patients with only one kidney Evidence of liver disease as indicated by alanine transaminase (ALT) and aspartate transaminase (AST) and/or total bilirubin ≥ 3 × the upper limit of normal (ULN) Hyperkalemia (>5.5mmol/L) Patients with sodium depletion is not correct or Patients with fluid depletion is not correct Chronic inflammation Patients with severe eye-related disorders (Retinal bleeding within 6 months, Blindness, Hypertension complications with Retinal micro-aneurysms) Diabetes mellitus Hematologic/oncologic, neurologic and psychiatric diseases Females who were pregnant, breastfeeding, planning a pregnancy or who were of childbearing potential Contraindications for amlodipine, losartan, olmesartan medoxomil, or other ARBs With known allergic reaction, lack of response or contraindication to Angiotensin II receptor antagonists Mean DBP > 110 mmHg Patients who took antihyperlipidemic agents within 30 days Subject who have participated in other clinical trial within the last one month Any subjects who are unable to cooperate with protocol requirements and follow-up procedures or who are in medical condition that is not eligible to be entered in investigators' discretion

Ages Eligible for Study
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Minimum Age: 55 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: SEVIKAR<br>Subjects who are eligible for the inclusion and exclusion criteria will be treated with Sevikar 5/20mg for 4 weeks. If subjects fail to reach the SBP threshold of SeSBP≥ 140mmHg after 4-week treatment, they will receive Sevikar 5/40mg for 4 weeks. At the end of 4-week treatment, subjects who fail to reach SBP threshold will receive Sevikar 10/40mg for 4 weeks. Subjects who can reach SBP threshold will continue to treat with current dose until 12 weeks. | Drug: SEVIKAR<br> <br> * Other names: amlodipine + olemsartan;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| change in mean 24-hour ABPM SBP |  | from baseline to Week 12 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| value of cuff SeSBP/SeDBP |  | baseline, week 4, week 8 and week 12 | 
| change in aortic PWV |  | from baseline to week 4, week 8, week 12 | 
| change in 24-hour ABPM DBP |  | baseline to week 12 | 
| change in hsCRP, HOMA-IR, MAU, Uric acid |  | from baseline to week 12 |