Health-related quality of life impact of a triple combination of olmesartan medoxomil, amlodipine besylate and hydrochlorotiazide in subjects with hypertension.

BACKGROUND: A post-hoc analysis was performed on the data from a 54 weeks phase III study (ClinicalTrials.gov identifier: NCT00923091) to measure changes in the health-related quality of life (HRQoL) of 2,690 patients aged ≥18 with moderate-to-severe hypertension who received one of six doses of olmesartan/amlodipine/hydrochlorothiazide (OLM/AML/HCTZ), using the MINICHAL and EQ-5D instruments. METHODS: Descriptive statistics were used to assess blood pressure and HRQoL scores over the study period. Analysis of covariance (ANCOVA) was used to identify those factors that could possibly have influenced HRQoL. Linear regression was used to assess the relationship between changes in blood pressure and HRQoL scores. RESULTS: Patients' baseline MINICHAL mood and somatic domains scores were 5.5 and 2.6. Over the study period HRQoL improved as both MINICHAL scores decreased by 31-33%. Patients' baseline EQ-5D index and VAS scores were 0.9 and 73.4 respectively, increasing by 6% and 12% over the study period. Patients' QALY gain over the 54 weeks study period was estimated to be 0.029 QALYs. The ANCOVA showed that changes in patients' HRQoL was likely to have been influenced by patients' achievement of blood pressure control, the amount of concomitant medication and patients' last used dosage strength of antihypertensive. Linear regression showed that blood pressure improvement may have been associated with improved HRQoL. CONCLUSIONS: This study showed that OLM/AML/HCTZ reduced blood pressure and significantly increased blood pressure control whilst improving patients' HRQoL. Achieving blood pressure control, amount of concomitant medication and dosage strength of antihypertensive impacted on patients' HRQoL.

A rat model of Charcot-Marie-Tooth disease 1A recapitulates disease variability and supplies biomarkers of axonal loss in patients.

Charcot-Marie-Tooth disease is the most common inherited neuropathy and a duplication of the peripheral myelin protein 22 gene causes the most frequent subform Charcot-Marie-Tooth 1A. Patients develop a slowly progressive dysmyelinating and demyelinating peripheral neuropathy and distally pronounced muscle atrophy. The amount of axonal loss determines disease severity. Although patients share an identical monogenetic defect, the disease progression is strikingly variable and the impending disease course can not be predicted in individual patients. Despite promising experimental data, recent therapy trials have failed. Established clinical outcome measures are thought to be too insensitive to detect amelioration within trials. Surrogate biomarkers of disease severity in Charcot-Marie-Tooth 1A are thus urgently needed. Peripheral myelin protein 22 transgenic rats harbouring additional copies of the peripheral myelin protein 22 gene ('Charcot-Marie-Tooth rats'), which were kept on an outbred background mimic disease hallmarks and phenocopy the variable disease severity of patients with Charcot-Marie-Tooth 1A. Hence, we used the Charcot-Marie-Tooth rat to dissect prospective and surrogate markers of disease severity derived from sciatic nerve and skin tissue messenger RNA extracts. Gene set enrichment analysis of sciatic nerve transcriptomes revealed that dysregulation of lipid metabolism associated genes such as peroxisome proliferator-activated receptor gamma constitutes a modifier of present and future disease severity. Importantly, we directly validated disease severity markers from the Charcot-Marie-Tooth rats in 46 patients with Charcot-Marie-Tooth 1A. Our data suggest that the combination of age and cutaneous messenger RNA levels of glutathione S-transferase theta 2 and cathepsin A composes a strong indicator of disease severity in patients with Charcot-Marie-Tooth 1A, as quantified by the Charcot-Marie-Tooth Neuropathy Score. This translational approach, utilizing a transgenic animal model, demonstrates that transcriptional analysis of skin biopsy is suitable to identify biomarkers of Charcot-Marie-Tooth 1A.

Olmesartan medoxomil plus amlodipine increases efficacy in patients with moderate-to-severe hypertension after monotherapy: a randomized, double-blind, parallel-group, multicentre study.

BACKGROUND AND OBJECTIVE: Hypertension remains a major global health problem, and evidence suggests that the majority of patients will require two or more antihypertensive agents in order to reach specified BP targets. Combining two drugs from different classes has the potential to target different aspects of hypertension, which may result in additional BP decreases compared with either agent used alone. This randomized, double-blind, parallel-group, multicentre trial in patients with moderate-to-severe hypertension (systolic BP [SBP]/diastolic BP [DBP] > or =160/100 mmHg) investigated the additional efficacy in BP reduction and BP goal rates (<140/90 mmHg for patients without diabetes mellitus, <130/80 mmHg for patients with diabetes) achieved by adding amlodipine 5 or 10 mg/day to olmesartan medoxomil (hereafter olmesartan) 20 mg/day in patients not adequately controlled on olmesartan monotherapy. METHODS: After 8 weeks' open-label olmesartan 20 mg monotherapy, 538 patients with SBP/DBP > or =140/90 mmHg were randomized to 8 weeks' double-blind therapy with olmesartan/placebo, olmesartan/amlodipine 20 mg/5 mg or olmesartan/amlodipine 20 mg/10 mg. This trial is registered on the www.clinicaltrials.gov website (NCT00220220). RESULTS: After 8 weeks (with last observation carried forward), the adjusted mean change in seated DBP (SeDBP) from baseline was -7.6 mmHg for olmesartan/placebo, -10.4 mmHg for olmesartan/amlodipine 20 mg/5 mg (p = 0.0006 vs olmesartan/placebo) and -10.9 mmHg for olmesartan/amlodipine 20 mg/10 mg (p < 0.0001 vs olmesartan/placebo). Mean changes in SeSBP from baseline with olmesartan/amlodipine 20 mg/5 mg and olmesartan/amlodipine 20 mg/10 mg were -16.1 and -16.7 mmHg, respectively (p < 0.0001 for both dose regimens vs olmesartan/placebo). BP goal rates were significantly higher with olmesartan/amlodipine 20 mg/5 mg and olmesartan/amlodipine 20 mg/10 mg (44.5% and 45.8%, respectively; p = 0.0011 and p = 0.0004, respectively) versus olmesartan/placebo (28.5%). Combination therapy was well tolerated, and the incidence of drug-related adverse events was 8.9% for olmesartan/placebo, 7.7% for olmesartan/amlodipine 20 mg/5 mg, and 11.3% for olmesartan/amlodipine 20 mg/10 mg (p = 0.490). Most adverse events were mild in severity and were well known drug-class issues. CONCLUSIONS: Combining olmesartan and amlodipine resulted in significantly greater BP lowering in patients not achieving adequate BP control with olmesartan monotherapy, thus allowing a significantly greater proportion of patients to achieve BP goal.

Efficacy and safety of a stepped-care regimen using olmesartan medoxomil, amlodipine and hydrochlorothiazide in patients with moderate-to-severe hypertension: an open-label, long-term study.

BACKGROUND: Treatment guidelines recommend combination therapy to control blood pressure (BP) in the majority of hypertensive patients. This long-term open-label study assessed a treatment algorithm based on olmesartan medoxomil (hereafter olmesartan), amlodipine and hydrochlorothiazide (HCTZ). METHODS: Patients with moderate-to-severe hypertension who were inadequately controlled with amlodipine 5 mg/day monotherapy and who subsequently completed 16 weeks of double-blind combination treatment with olmesartan and amlodipine entered a 28-week open-label phase in which all patients initially received olmesartan/amlodipine 40/5 mg/day. After 4, 10 and 19 weeks, patients with inadequately controlled hypertension (seated trough diastolic [DBP] and systolic [SBP] BP >/=90 mmHg and >/=140 mmHg, respectively) had their doses increased in a step-wise manner to: (i) olmesartan/amlodipine 40/10 mg; (ii) olmesartan/amlodipine/HCTZ 40/10/12.5 mg; and (iii) olmesartan/amlodipine/HCTZ 40/10/25 mg. RESULTS: In total, 692 patients entered the open-label phase (691 on olmesartan/amlodipine 40/5 mg). The majority of patients remained on olmesartan/amlodipine 40/5 mg without dose elevation, and, of these, 74.3% achieved goal BP at study completion or early termination. Additional patients achieved goal BP with each successive uptitration of therapy: in patients who finished the study on olmesartan/amlodipine 40/10 mg and olmesartan/amlodipine/HCTZ 40/10/12.5 mg, the respective proportions who reached goal BP were 59.0% and 47.1%. Overall, 66.9% of patients achieved the European guideline recommended goal BP of SBP <140 mmHg and DBP <90 mmHg for patients without diabetes mellitus, and SBP <130 mmHg and DBP <80 mmHg for patients with diabetes. Treatment was generally well tolerated, with no unexpected safety concerns. CONCLUSIONS: A treatment algorithm based on olmesartan/amlodipine (+/- HCTZ) provides a high degree of BP control in patients with moderate-to-severe hypertension. The open-label study design suggests similar results are obtainable in clinical practice.

Efficacy and tolerability of olmesartan medoxomil combined with amlodipine in patients with moderate to severe hypertension after amlodipine monotherapy: a randomized, double-blind, parallel-group, multicentre study.

BACKGROUND AND OBJECTIVES: Cerebrovascular and cardiac adverse events can be significantly reduced by effective antihypertensive therapy; however, BP control rates remain poor. The objective of this randomized, double-blind, parallel-group, multicentre study was to determine the efficacy and safety of olmesartan medoxomil/amlodipine combination therapy in patients with moderate to severe hypertension who had failed to respond to treatment with 8 weeks of open-label amlodipine. METHODS: A total of 1017 patients entered the open-label amlodipine monotherapy stage; mean BP at week 0 was 164/102 mmHg. After 8 weeks of amlodipine monotherapy (5 mg/day), non-responding patients (n = 755) were randomized to receive placebo plus amlodipine 5 mg or a combination of olmesartan medoxomil (10-40 mg) with amlodipine 5 mg for 8 weeks. At week 16, patients who had achieved diastolic BP (DBP) <90 mmHg and/or systolic BP (SBP) <140 mmHg continued on randomized treatment for a further 8 weeks. Patients in whom both SBP and DBP were >or=140/90 mmHg at week 16 had their medication uptitrated to olmesartan medoxomil/amlodipine 20/5 mg, olmesartan medoxomil/amlodipine 40/5 mg or olmesartan medoxomil/amlodipine 40/10 mg. RESULTS: Combination of olmesartan medoxomil (10-40 mg) with amlodipine 5 mg for 8 weeks (double-blind) reduced mean SBP/DBP by up to 16.8 mmHg and 9.6 mmHg, respectively. The additional adjusted mean change in seated DBP (SeDBP) [primary endpoint] with last observation carried forward (LOCF) compared with placebo/amlodipine 5 mg was -2.0 mmHg (p = 0.0207), -3.7 mmHg (p < 0.0001) and -3.8 mmHg (p < 0.0001) for olmesartan medoxomil/amlodipine 10/5 mg, 20/5 mg and 40/5 mg, respectively. The corresponding additional adjusted mean change in SeSBP compared with placebo/amlodipine 5 mg was -3.5 mmHg (p = 0.0103), -5.8 mmHg (p < 0.0001) and -7.1 mmHg (p < 0.0001) for the olmesartan medoxomil/amlodipine 10/5 mg, 20/5 mg and 40/5 mg groups, respectively. Uptitration was associated with further mean reductions of up to 12.6 mmHg (SeSBP) and 8.2 mmHg (SeDBP), and allowed additional patients to achieve goal BP. Target BP was defined using both SBP and DBP criteria (patients without diabetes <140/90 mmHg; patients with diabetes <130/80 mmHg). More than 70% of patients on active combination therapy achieved their BP goal by week 24. All combination regimens were well tolerated. CONCLUSION: These results suggest that olmesartan medoxomil combined with amlodipine is effective and well tolerated in reducing BP in patients with moderate to severe hypertension.