Effects of olmesartan medoxomil on systolic blood pressure and pulse pressure in the management of hypertension

Background: In this analysis, we evaluated the efficacy of the angiotensin 11 receptor blocker olmesartan medoxomil in reducing systolic blood pressure (SBP) and pulse pressure (PP) in hypertensive patients. Methods: Data from seven randomized, double blind, placebo controlled, 6- to 12-week efficacy trials of olmesartan 20 mg and 40 mg/day were analyzed to determine changes in trough seated SBP and PP within three cohorts: 1) total cohort (n = 1777); 2) subjects with a wide PP: that is, those with a baseline PP >55 mm Hg (n = 917); and 3) a subpopulation of patients with a wide PP and age greater than or equal to65 years (n = 296). Statistical comparisons used least squares mean values. Results: In the total cohort, olmesartan 20 and 40 mg/day resulted in mean reductions in SBP of 15.1 and 17.6 mm Hg, respectively (P < .001 v placebo). In the wide PP cohort, olmesartan resulted in mean reductions in SBP of 17.7 and 22.0 mm Hg and mean reductions in PP of 7.4 Hg and 8.8 mm Hg for the groups receiving 20 and 40 mg/day, respectively (P < .001 v placebo). In the cohort with wide PP and age greater than or equal to65 years, olmesartan 20 and 40 mg/day produced mean reductions in SBP of 21.8 and 22.5 turn Hg, and PP of 6.7 and 7.6 mm Hg, respectively (P < .05 v placebo). Conclusions: Olmesartan significantly reduces SBP and PP, and these reductions are more pronounced in patients with a wide baseline PP. In patients with a wide baseline PP and age = greater than or equal to65 years, the population at greatest risk for cardiovascular morbidity and mortality, olmesartan reduces PP to an extent similar to that in patients <65 years of age. (C) 2004 American Journal of Hypertension, Ltd.