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American Thoracic Society: American Society of Hypertension

American Thoracic Society

Olmesartan/Hydrochlorothiazide (Benicar HCT) versus Amlodipine/Benazepril (Lotrel)

Presenter: Henry Punzi, MD, Director, Punzi Medical Center and Hypertension Research Institute, Carrollton, Texas Current hypertension guidelines call for a step approach,

beginning first with one drug, then adding others. Advocates of initial combination therapy have long complained that anti-hypertensive monotherapy rarely achieves treatment goals, but they have not had the data to make their case for first-line combination therapy. Results from trials of combination therapy, however, may fill that void.

Dr. Punzi acknowledged the reluctance of many clinicians to start off with a strong combination therapy.

“The drugs in the old days dropped pressure so rapidly that it was dangerous, and a lot of family physicians became very concerned. But now we have much better drugs. The fixed-dose combinations are very carefully put together.”
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He presented the results of a 12-week study that compared olmesartan medoxomil plus a thiazide (Benicar HCT, Daiichi Sankyo) with amlodipine besylate/benazepril (Lotrel, Novar-tis) in 190 patients with stage 2 hypertension. Both combinations were more effective in lowering systolic blood pressure (BP) than either olmesartan (Benicar) or amlodipine (Nor-vasc, Pfizer) alone. Compared head-to-head, olmesartan/ hydrochlorothiazide (40 mg/12.5 or 25 mg) outperformed amlodipine plus benazepril (5-10 mg/20 mg). The former combination resulted in a mean reduction of 33 mm Hg in systolic BP from baseline, compared with a decline of 27 mm Hg for the latter.

Among the olmesartan/thiazide patients, 66% reached a goal of 140/90 mm Hg or lower, and 33% achieved 130/80 mm Hg or lower. In the amlodipine/benazepril group, 45% reached the first goal, and 14% reached the second goal.

Dr. Punzi concluded that hesitation to use combination therapy might do more harm than good.

“The VALUE [Valsartan Antihypertensive Long-term Use Evaluation] trial showed us that if you don’t control blood pressure well within the first six months, you get higher morbidity and mortality. Why mess around with monotherapy when we have safe and effective combination therapies?”

Olmesartan and Amlodipine

Presenter: Steven Chrysant, MD, Oklahoma Cardiovascular and Hypertension Center, Oklahoma City, Oklahoma

Dr. Chrysant demonstrated that a calcium-channel blocker/ angiotensin receptor blocker (CCB/ARB) combination improved blood pressure control without increasing the risk of adverse effects. He compared combinations of olmesartan medoxomil, 10 to 40 mg daily, plus amlodipine, 5 to 10 mg daily (Azor, Daiichi Sankyo), with either drug alone or placebo in 1,940 patients with mild-to-severe hypertension.

High-dose monotherapy with both amlodipine and olme-sartan produced good reductions in BP, he said, “but only the combination can get you below 140 mm Hg systolic.”

In addition to reducing systolic pressure, the combination produced a strong lowering effect in diastolic BP. By adding progressively higher doses of olmesartan while lowering the amlodipine dose, he suggested that foot edema could be reduced. viagra soft

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