Olmesartan vs. ramipril in elderly hypertensive patients: review of data from two published randomized, double-blind studies.
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2014-03-11
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Abstract
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the activity and safety of ARBs and ACE inhibitors in elderly hypertensive patients Aim of this review of published and unpublished pooled data from two recent randomized double blind controlled trials is to offer a comprehensive head to head comparison of the antihypertensive efficacy of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