Olmesartan vs. ramipril in elderly hypertensive patients: review of data from two
published randomized, double-blind studies.
Author(s): Omboni S(1), Malacco E, Mallion JM, Fabrizzi P, Volpe M.
Affiliation(s): Author information:
(1)Italian Institute of Telemedicine, Via Colombera 29, 21048, Solbiate Arno
(Varese), Italy, stefano.omboni@iitelemed.org.
Publication date & source: 2014, High Blood Press Cardiovasc Prev. , 21(1):1-19
Hypertension is a frequent condition among individuals over 65 years of age
worldwide and is one of the most important risk factors for cardiovascular (CV)
disease. Effective drug treatment of elderly hypertensives is usually associated
with a marked reduction in CV morbidity and mortality. Among the different
classes of antihypertensive agents, angiotensin receptor blockers (ARBs) and
ACE-inhibitors are supposed to provide the best efficacy in lowering blood
pressure (BP) and protecting target organ damage while featuring a good
tolerability profile. However, up to date, few randomized clinical studies have
directly compared the activity and safety of ARBs and ACE-inhibitors in elderly
hypertensive patients. Aim of this review of published and unpublished pooled
data from two recent randomized, double-blind, controlled trials, is to offer a
comprehensive head-to-head comparison of the antihypertensive efficacy of the ARB
olmesartan medoxomil vs. the ACE-inhibitor ramipril in a large study population
including more than 1,400 hypertensive subjects aged 65-89 years with
mild-to-moderate essential hypertension. The efficacy of the two drugs was
separately evaluated in subgroups of patients classified according to the
presence of metabolic syndrome, reduced renal function, CV risk level, gender,
class of age, type of arterial hypertension and previous antihypertensive
treatments. Olmesartan showed a greater efficacy than ramipril both in terms of
clinic BP reduction and rate normalization. Olmesartan appeared significantly
superior to ramipril in providing a more homogeneous and long-lasting 24-h BP
control and maintaining an effective antihypertensive action in the last 6-h
period from drug intake. In subgroups of patients with additional clinical
conditions, olmesartan gave comparable, and in some cases greater, BP responses
than those achieved with the ACE-inhibitor. The incidence of adverse events was
similar for both drugs. Olmesartan may thus represent an effective alternative to
ACE-inhibitors among first-line drug treatments for hypertension in older people.
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