Azelnidipine plus olmesartan versus amlodipine plus olmesartan on arterial stiffness and cardiac function in

Takeshi Takami1, Yoshihiko Saito

  • 1Department of Internal Medicine, Clinic Jingumae, Kashihara, Nara, Japan. takami66@m5.kcn.ne.jp

Insights

Olmesartan with azelnidipine improved central blood pressure, left ventricular mass, and arterial stiffness more than olmesartan with amlodipine over two years. These findings highlight azelnidipine

Area of Science:

  • Cardiology
  • Pharmacology
  • Hypertension Research

Background:

  • Hypertension management requires effective strategies to prevent cardiovascular complications.
  • Central blood pressure (CBP) and arterial stiffness are key indicators of cardiovascular risk.
  • Left ventricular (LV) remodeling and diastolic dysfunction are consequences of uncontrolled hypertension.

Purpose of the Study:

  • To compare the long-term effects of olmesartan/azelnidipine versus olmesartan/amlodipine on cardiovascular parameters.
  • To evaluate impacts on central blood pressure, LV mass index (LVMI), LV diastolic function, and arterial stiffness.

Main Methods:

  • Patients with inadequately controlled hypertension received olmesartan monotherapy.
  • Add-on therapy with either azelnidipine or amlodipine was administered for two years.
  • Measurements included central blood pressure, LVMI, LV diastolic function indices, and arterial stiffness parameters (baPWV, AIx).

Main Results:

  • Both add-on therapies significantly improved brachial and central blood pressure, LVMI, LV diastolic function, and arterial stiffness.
  • Olmesartan/azelnidipine demonstrated significantly greater improvements in CBP, LVMI, LV diastolic function (E/A ratio), and arterial stiffness (baPWV, AIx) compared to olmesartan/amlodipine.
  • Multivariate analysis indicated independent associations between arterial stiffness, central blood pressure, and LV diastolic function.

Conclusions:

  • Olmesartan/azelnidipine offers superior benefits for central hemodynamics, cardiac structure, and vascular health compared to olmesartan/amlodipine in hypertensive patients.
  • Improvements in LV diastolic function are linked to concurrent enhancements in arterial stiffness.
  • These findings support azelnidipine as a valuable option for add-on therapy in managing resistant hypertension.
Abstract

Related Concept Videos

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
Antihypertensive Drugs: Angiotensin II Receptor Blockers01:30

Antihypertensive Drugs: Angiotensin II Receptor Blockers

In the renin-angiotensin-aldosterone system, a hormone called angiotensin II plays a crucial role. It binds to the AT1 receptors in vascular smooth muscles coupled with Gq proteins. The activation of these receptors activates an enzyme called phospholipase C, which releases two molecules: inositol trisphosphate and diacylglycerol. These molecules cause a chain reaction that leads to the phosphorylation of myosin light chains and promotes interaction between actin and myosin, leading to smooth...
Atherosclerosis III: Management01:26

Atherosclerosis III: Management

Management of atherosclerosis involves an integrated strategy encompassing pharmacological treatment, surgical interventions, lifestyle changes, and nutrition therapy to address the multifactorial nature of the disease.Pharmacological TherapyA cornerstone of atherosclerosis management is the use of pharmacological agents. Statins, such as atorvastatin, are pivotal in inhibiting HMG-CoA reductase, an enzyme that catalyzes an initial step in cholesterol synthesis in the liver. This reduction in...
Hypertension III: Clinical Manifestations and Diagnostic Studies01:30

Hypertension III: Clinical Manifestations and Diagnostic Studies

Hypertension is asymptomatic and also referred to as the "silent killer" until it progresses to a severe stage or causes target organ disease. Patients may experience symptoms stemming from the strain on blood vessels and tissues in various organs or the heart's increased workload.Physical exams might show no abnormalities other than high blood pressure. Signs of vascular damage, when present, correspond to the organs supplied by the affected vessels, leading to target organ damage. For...
Antihypertensive Drugs: Vasodilators01:23

Antihypertensive Drugs: Vasodilators

Vasodilators, primarily affecting the smooth muscles within arterial and venous walls, are commonly used for hypertension treatment. Medications such as minoxidil and hydralazine primarily target arteries and arterioles, while sodium nitroprusside acts on arterioles and venules. Minoxidil, functioning as a prodrug, is metabolized by hepatic sulfotransferase into its active form, minoxidil sulfate, after oral administration. This metabolite binds to the sulfonylurea receptor (SUR) component of...
Hypertension IV: Drug Therapy and Lifestyle Modifications01:28

Hypertension IV: Drug Therapy and Lifestyle Modifications

Multiple classes of antihypertensive medications are employed in treating hypertension. The most commonly recommended first-line treatments include:Thiazide Diuretics, such as chlorthalidone, increase sodium and water excretion from the body, reducing blood volume and blood pressure.Angiotensin-converting enzyme inhibitors, like lisinopril, block the conversion of angiotensin I to II, a potent vasoconstrictor lowering blood pressure.Angiotensin II Receptor Blockers (ARBs) prevent angiotensin II...