What is Benicar and how does it work. What are the main uses of Benicar. How is Benicar dosed and what are its potential side effects. Who should avoid taking Benicar. What are the key facts about Benicar’s effectiveness in treating hypertension.

Understanding Benicar: An In-depth Look at this Hypertension Medication

Benicar, a prescription medication manufactured by Daiichi Sankyo, has become a significant player in the treatment of hypertension. The active ingredient in Benicar is olmesartan medoxomil, which is also available as a generic formulation. This medication belongs to the angiotensin II receptor blocker (ARB) drug class, functioning by blocking angiotensin II, a hormone responsible for blood vessel constriction and elevated blood pressure.

The U.S. Food and Drug Administration (FDA) granted approval for brand name Benicar in 2002 specifically for the treatment of high blood pressure. In 2003, the FDA also approved Benicar HCT, a combination drug containing olmesartan and hydrochlorothiazide, the latter being a thiazide diuretic.

Benicar’s Effectiveness in Clinical Trials

Clinical trials have demonstrated the efficacy of Benicar in reducing blood pressure. A single 20 mg dose of olmesartan was found to decrease blood pressure by approximately 10/6 mmHg, while a 40 mg dose achieved a reduction of about 12/7 mmHg. These results highlight the potency of Benicar in managing hypertension.

The Prevalence of Benicar and Olmesartan in Hypertension Treatment

Benicar and its generic versions have become widely prescribed medications in the United States. According to the U.S. Department of Health and Human Services’ Medical Expenditure Panel Survey data from 2017, olmesartan medoxomil ranked among the top 300 most prescribed drugs, with over 2 million prescriptions. The combination of olmesartan medoxomil and hydrochlorothiazide also made it to this list, with over 1 million prescriptions.

The Scope of Hypertension in the United States

The Centers for Disease Control and Prevention (CDC) estimates that approximately 75 million adults in the United States have high blood pressure, affecting roughly one in every three adults. Alarmingly, only about half of these individuals have their condition under control. Among those with high blood pressure, seven out of ten are taking medication to manage their condition, which may include Benicar or olmesartan-containing drugs.

How Does Benicar Work to Control Blood Pressure?

Benicar’s mechanism of action involves blocking the effects of angiotensin II, a hormone that causes blood vessels to constrict. By preventing this constriction, Benicar helps to relax and widen blood vessels, thereby reducing blood pressure. This action is crucial in managing hypertension and reducing the risk of associated complications such as heart disease and stroke.

Understanding Blood Pressure Measurements

Blood pressure is measured using two numbers: systolic and diastolic. The systolic pressure represents the force when the heart beats, while the diastolic pressure indicates the force when the heart is at rest between beats. A normal blood pressure reading is typically below 120/80 mmHg.

• Systolic pressure: The higher number, representing pressure when the heart beats
• Diastolic pressure: The lower number, indicating pressure when the heart rests between beats

The Importance of Blood Pressure Control and Benicar’s Role

Uncontrolled high blood pressure significantly increases the risk of heart disease and stroke, which are leading causes of death in the United States. What makes hypertension particularly dangerous is its often asymptomatic nature, meaning many individuals may be unaware of their condition. This underscores the importance of regular blood pressure checks and appropriate treatment when necessary.

For patients diagnosed with hypertension, medications like Benicar can play a crucial role in reducing the risk of serious cardiovascular events. By effectively lowering blood pressure, Benicar helps mitigate the long-term health risks associated with uncontrolled hypertension.

Can Benicar completely cure hypertension?

While Benicar is highly effective in managing high blood pressure, it’s important to understand that it does not cure hypertension. Instead, it helps control blood pressure levels when taken as prescribed. Patients typically need to continue the medication long-term, often in conjunction with lifestyle modifications, to maintain optimal blood pressure control.

Who Should Avoid Taking Benicar?

Despite its effectiveness in treating hypertension, Benicar is not suitable for everyone. Certain groups of people should avoid using this medication due to potential risks and complications.

1. Pregnant women: Benicar can cause serious complications for fetuses, especially during the second and third trimesters. Some of these complications can be fatal to the fetus.
2. Nursing mothers: The medication may pass into breast milk and affect the nursing infant.
3. Children under one year of age: Benicar can negatively impact the growth and development of kidneys in very young children.
4. Patients with blood volume or salt depletion: These individuals should start with a lower dose if Benicar is prescribed.
5. Patients with renal artery stenosis: This condition, characterized by stiffening of renal arteries, can be exacerbated by Benicar.

What should pregnant women know about Benicar?

Pregnant women should be particularly cautious about Benicar use. The medication can cause fetal toxicity and is not recommended during pregnancy. If a woman becomes pregnant while taking Benicar, it’s crucial to discontinue the medication as soon as possible and consult with a healthcare provider for alternative blood pressure management strategies.

Common and Serious Side Effects of Benicar

Like all medications, Benicar can cause side effects. While some side effects are common and generally mild, others can be more serious and require immediate medical attention.

Common Side Effects

The most frequently reported side effect of Benicar is dizziness. Other common side effects (occurring in more than 1% of patients) include:

• Back pain
• Bronchitis
• Increase of creatinine phosphokinase (CPK)
• Diarrhea
• Headache

Serious Side Effects

While less common, some patients may experience more severe side effects when taking Benicar. These include:

• Facial edema (angioedema)
• High potassium levels (hyperkalemia)
• Low blood pressure (hypotension)
• Decreased kidney function

Sprue-like Enteropathy: A Rare but Serious Concern

In 2013, the FDA issued a safety announcement warning about the potential for Benicar to cause intestinal problems known as sprue-like enteropathy. This condition can develop months to years after starting the medication and is characterized by:

• Severe, chronic diarrhea
• Substantial weight loss

Patients experiencing these symptoms should seek medical attention promptly.

Proper Dosage and Administration of Benicar

The appropriate dosage of Benicar can vary depending on individual factors such as the severity of hypertension, patient age, and overall health status. It’s crucial to follow the prescribing physician’s instructions carefully.

What is the typical starting dose for Benicar?

For most adults, the recommended starting dose of Benicar is 20 mg once daily. However, some patients may be started on a lower dose of 10 mg, especially if they have conditions that might affect how their body processes the medication. The maximum recommended dose is 40 mg once daily.

Dosage Adjustments

Dosage may be adjusted based on blood pressure response. If blood pressure is not adequately controlled with Benicar alone, other antihypertensive agents may be added to the treatment regimen. It’s important to note that the full effect of Benicar may not be seen for 1-2 weeks after starting treatment or increasing the dose.

Monitoring and Follow-up While Taking Benicar

Regular monitoring is essential for patients taking Benicar to ensure its effectiveness and detect any potential side effects early. This typically involves:

• Regular blood pressure checks
• Periodic blood tests to monitor kidney function and potassium levels
• Reporting any unusual symptoms to the healthcare provider promptly

How often should blood pressure be checked while on Benicar?

The frequency of blood pressure checks can vary depending on individual circumstances. Initially, more frequent monitoring may be necessary to ensure the medication is working effectively and the dosage is appropriate. Once blood pressure is stabilized, checks may be less frequent, but regular monitoring should continue throughout treatment.

Interactions with Other Medications and Substances

Benicar can interact with various other medications and substances, potentially affecting its efficacy or increasing the risk of side effects. It’s crucial for patients to inform their healthcare providers about all medications, supplements, and herbal products they are taking.

Common Drug Interactions

Some medications that may interact with Benicar include:

• Other blood pressure medications
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Lithium
• Potassium supplements

Does alcohol consumption affect Benicar’s effectiveness?

Alcohol can potentially interact with Benicar, leading to increased side effects such as dizziness and lightheadedness. It’s generally advisable to limit alcohol consumption while taking this medication and to discuss specific concerns with a healthcare provider.

Long-term Outlook for Patients on Benicar

For many patients with hypertension, Benicar can be an effective long-term treatment option. When used as part of a comprehensive treatment plan that includes lifestyle modifications, it can significantly reduce the risk of serious cardiovascular events.

Lifestyle Modifications to Complement Benicar Treatment

While Benicar can effectively lower blood pressure, it’s most effective when combined with healthy lifestyle habits. These may include:

• Maintaining a healthy diet low in sodium and rich in fruits and vegetables
• Regular physical activity
• Maintaining a healthy weight
• Limiting alcohol consumption
• Quitting smoking

These lifestyle changes can enhance the effectiveness of Benicar and contribute to overall cardiovascular health.

What is the prognosis for patients taking Benicar long-term?

For most patients who tolerate Benicar well and maintain good blood pressure control, the long-term outlook is positive. Regular follow-ups with healthcare providers, adherence to prescribed treatment, and adoption of heart-healthy lifestyle habits can significantly reduce the risk of hypertension-related complications and improve overall quality of life.

In conclusion, Benicar represents an important tool in the management of hypertension. Its effectiveness, coupled with a generally favorable side effect profile, has made it a popular choice among healthcare providers. However, like all medications, it requires careful consideration of individual patient factors, regular monitoring, and open communication between patients and their healthcare teams to ensure safe and effective use.

Guide to Uses, Dosage & Side Effects

Benicar is a prescription blood pressure medication manufactured by Japanese drugmaker Daiichi Sankyo. Its active ingredient is olmesartan medoxomil, which is available as a generic formulation. The medication belongs to the angiotensin II receptor blocker, or ARB, drug class and works by blocking a hormone called angiotensin II, which causes blood vessel constriction and high blood pressure.

The U.S. Food and Drug Administration first approved brand name Benicar in 2002 to treat high blood pressure. Then in 2003, it approved Benicar HCT — a drug that contains both olmesartan with hydrochlorothiazide, a blood pressure drug from the thiazide diuretic drug class.

In clinical trials, one 20 mg dose of olmesartan reduced blood pressure by about 10/6 mmHg and 40 mg reduced it by about 12/7 mmHg.

Millions of Americans use Benicar and its generics each year.

The Centers for Disease Control and Prevention defines blood pressure as the force of blood against the artery walls as it circulates through the body.

Olmesartan medoxomil is one of the top 300 most prescribed drugs in the United States in 2017 with over 2 million prescriptions, according to the U.S. Department of Health and Human Services’ most recent Medical Expenditure Panel Survey data.

The combination of olmesartan medoxomil and hydrochlorothiazide was also in the top 300 most prescribed drugs in 2017 with over 1 million prescriptions.

What Does Benicar Treat?

Benicar is indicated for the treatment of hypertension, also known as high blood pressure. It is used to lower blood pressure.

Blood pressure rises as blood vessels constrict. While it’s normal for blood pressure to rise and fall throughout the day, health problems can develop for individuals whose blood pressure remains high for a longer period of time.

Blood pressure is measured by two numbers. The first number, referred to as systolic, represents pressure when the heart beats and is the higher number. The second number, referred to as diastolic, is the pressure when the heart rests in between beats. The blood pressure value is expressed as systolic over diastolic. For example, a systolic of 120 and diastolic of 80 is written as “120/80 mmHg”. A normal blood pressure is less than 120/80 mmHg.

When left unchecked, elevated blood pressure levels greatly increase a person’s risk for heart disease and stroke, leading causes of death in the United States. High blood pressure usually has no accompanying symptoms, so many people are unaware that there’s even a problem.

The Centers for Disease Control and Prevention estimated that 75 million adults have high blood pressure in the United States. It affects approximately one in every three adults.

Just over one half of individuals with high blood pressure are controlled. Seven in 10 of those adults with high blood pressure are taking a blood pressure medication. These individuals are sometimes prescribed a medication such as Benicar or a medication containing the ingredient olmesartan.

For patients suffering from high blood pressure, taking a medication for control, such as Benicar, can reduce the risk of heart attack and stroke.

Who Should Not Use Benicar?

Benicar can result in complications for fetuses, especially in the second and third trimesters, and some of these complications can be fatal to the fetus. Also, the drug should not be utilized in children under one, as it can negatively affect growth and development of the kidneys. Other individuals can experience adverse reactions when taking Benicar.

Benicar is not recommended for the following people:

• Pregnant women
• Nursing mothers
• Children under one year of age
• Patients with blood volume or salt depletion (a lower starting dose should be utilized)
• Patients with stiffening of renal arteries (also called renal artery stenosis)

Benicar Side Effects

The most common Benicar side effect is dizziness. Serious and less common side effects include facial edema (known as angioedema), high potassium levels (also known as hyperkalemia), low blood pressure (known as hypotension), and decreased kidney function.

Also, in 2013, the FDA released a safety announcement warning the public that Benicar has the potential to cause intestinal problems known as sprue-like enteropathy. Symptoms of drug-induced sprue-like enteropathy include severe, chronic diarrhea and substantial weight loss within months to years after beginning use of the medication.

Benicar can also result in fetal toxicity and is not recommended for women who are pregnant. Benicar should be discontinued as soon as possible when pregnancy is detected.

Common Side Effects (>1 percent occurrence)

• Back pain
• 
  Bronchitis
• 
  Increase of creatinine phosphokinase (CPK)
• 
  Diarrhea
• 
  Headache
• 
  Blood in urine
• 
  High blood sugar
• 
  Elevated triglyceride levels (fat in the blood)
• 
  Flu-like symptoms
• 
  Inflammation of pharynx or back of throat
• 
  Inflammation of mucous membrane inside the nose
• 
  Sinusitis

Less Common Side Effects (

• Chest pain
• 
  Fast heart rate
• 
  Peripheral edema
• 
  Weakness/lack of energy
• 
  Vertigo
• 
  Abdominal pain
• 
  Indigestion
• 
  Diarrhea
• 
  Nausea
• 
  High levels of cholesterol in blood
• 
  High concentration of fats in blood
• 
  Excess levels of uric acid in blood
• 
  Decreases in hemoglobin and hematocrit level
• 
  Elevations of liver enzymes and/or serum bilirubin levels
• 
  Increased blood creatinine levels
• 
  Joint pain
• 
  Arthritis
• 
  Muscle pain
• 
  Rhabdomyolysis (a condition causing destruction of skeletal muscle)
• 
  Rash
• 
  Acute kidney failure
• 
  Hair loss

Black Box Warning – Fetal Toxicity

A black box warning appears on a prescription drug’s label when the FDA wants to call attention to serious or life-threatening risks associated with its use. Benicar (olmesartan medoxomil) contains one of these warnings for fetal toxicity. The label says Benicar should be discontinued as soon as possible after pregnancy is detected. This is because olmesartan acts directly on the renin angiotensin system (a system in the body that regulates blood pressure), which can cause injury and death to the developing fetus.

The label says the risks are greater during the second and third trimesters. The risks include reduction of fetal renal function and increase in fetal and neonatal death.

This could lead to a decrease in amniotic fluid and result in fetal lung underdevelopment and skeletal deformations.

Potential neonatal adverse effects include:

• Skull underdevelopment
• Failure of kidneys to produce urine
• Low blood pressure
• Kidney failure
• Death

Benicar Dosages

Benicar comes in tablet form in three different prescription strengths: 5 milligrams (yellow/round pill), 20 milligrams (white/round pill), 40 milligrams (white/oval). This drug can be taken with or without food, and it can also be administered with a diuretic and/or other antihypertensive medications.

5 mg (yellow/round pill) dosage

20 mg (white/round pill) dosage

40 mg (white/oval) dosage

Dosage Information for Adults

• Recommended starting dosage of 20 milligrams once daily
• If further blood pressure reduction is required after two weeks of taking Benicar, the provider may increase the dose to 40 milligrams.
• Doses above 40 milligrams have not been shown to have any greater effect in patients.
• Twice-daily dosages do not appear to offer any advantage over the same total dose taken once daily.

Dosage Information for Children

• Dosing must be individualized
• Recommended starting dosage in children 6 years of age and older and weighing 44 to 77 pounds is 10 milligrams once daily
• If further reduction in blood pressure is required after two weeks of taking Benicar, the provider may increase the dose to a maximum of 20 milligrams once daily for those weighing under 77 pounds
• If further reduction in blood pressure is required after two weeks of taking Benicar, the provider may increase the dose to a maximum of 40 milligrams for those weighing over 77 pounds
• For children who cannot swallow pills, Benicar may be taken as a suspension.

Drug Interactions with Benicar

It is possible for Benicar to cause adverse reactions when taken concurrently with certain drugs (both prescription and nonprescription). These adverse reactions may include unfavorable side effects and/or decreased effectiveness of Benicar or the other drugs.

Drugs that Interact with Benicar

Aliskiren (Brand Name – Tekturna):

It is recommended that Benicar is not given in conjunction with aliskiren (antihypertensive drug) in patients with diabetes.

NonSteroidal Antiinflammatory Drugs (NSAID) including Selective COX-2 inhibitors:

Taking Benicar with NSAIDs, a type of pain medication including ibuprofen (Motrin) or naproxen (Aleve), can lead to decreased kidney function. Taking NSAIDs can also decrease the effects of Benicar.

Dual Blockade of the Renin-Angiotensin System (RAS):

Taking Benicar with other ARBs, ACE (angiotensin-converting enzyme) inhibitors (such as Captopril, Ramipril, Lisinopril, Quinapril and others) or aliskiren is associated with increased risks of low blood pressure, high potassium and changes in kidney function.

Colesevelam Hydrochloride (Brand Name – Welchol):

Taking colesevelam hydrochloride with Benicar reduces the effectiveness of Benicar. It is recommended that olmesartan is taken at least four hours prior to taking a dose of colesevelam hydrochloride in order to decrease the effect of the drugs’ interaction.

Mayo Clinic Study Confirms Olmesartan-Induced Enteropathy

Twenty-two patients who were seen at the Mayo Clinic between August 2008 and August 2011 were described in a study examining the link between olmesartan and unexplained sprue-like enteropathy. Olmesartan is an active ingredient in Benicar.

To be included in the study, patients had to have chronic diarrhea (lasting more than four weeks) while taking olmesartan. The cause of the symptoms could not be explained by another disorder, such as celiac disease; and finally, discontinuing the drug resulted in clinical improvement.

Mayo Clinic’s 2012 Report

In 2012, Mayo Clinic researchers published this study as a case series of sprue-like enteropathy associated with patients’ use of olmesartan.

2012 Results:

• The 22 subjects involved in the series presented similar clinical results to individuals of 23 adverse event reports identified by the FDA through its FDA’s Adverse Event Report System (FAERS).
• Of the 22 patients from 17 states treated by the Mayo Clinic between the years of 2008 to 2011, 14 required hospitalization with weight losses averaging almost 40 pounds, and one patient losing a total of about 125 pounds.
• None of the patients responded to gluten free diets (used for celiac disease sufferers).
• They were all taking daily doses of olmesartan ranging from 10 to 40 mg.
• When olmesartan was discontinued, the patients’ symptoms improved and they all experienced some degree of weight gain.

Mayo Clinic’s 2013 Report

In May 2013, an article was published describing patients with negative blood tests for celiac disease and villous atrophy, a condition in which the wall of the intestine erodes away.

2013 Results:

• The article reported that some patients without definitive causes for villous atrophy were categorized as having unclassified sprue.
• It was later discovered that some of these patients had villous atrophy associated with their use of olmesartan.

Olmesartan-induced enteropathy was further investigated using prescription refill information and Medicare insurance claims, which showed that patients using olmesartan had a higher rate of being diagnosed with celiac disease than users of other ARBs.

One 2022 clinical study noted the potential of olmesartan medoxomil nanoparticles delivered intranasally to improve the drug’s effectiveness. The engineered bioparticles showed a significant decrease in blood pressure and heart rate, suggesting the potential application of intranasal olmesartan medoxomil nanoparticles.

FDA-Initiated Label Change for Sprue-like Enteropathy

In 2013, the FDA issued a safety announcement about the potential for occurrences of sprue-like enteropathy. This decision came following its evaluation of FAERS, the Mayo Clinic case series and information from the Center for Medicare and Medicaid Services (CMS) database. The FDA also ordered the drug manufacturer to change its labeling on the blood pressure medication to include a warning about this.

In premarketing clinical trials, the incidence of adverse effects reported by Daiichi Sankyo related to olmesartan was similar to those of placebo, and the only negative effect linked directly to olmesartan with greater frequency than the placebo, as reported in the prescribing information, was dizziness. While millions of individuals have been prescribed olmesartan over the last several years, reports of severe gastrointestinal reactions associated with its use are claimed to not have surfaced until later in 2012.

Less than a year after the FDA ordered the label change for Benicar and other drugs containing olmesartan, patients who had suffered sprue-like enteropathy began filing Benicar lawsuits. Daiichi Sankyo, Benicar’s manufacturer, agreed in August 2017 to settle Benicar claims from about 2,300 plaintiffs in cases for $300 million.

In 2006, the U.S. Department of Health & Human Services (DOH) submitted a warning letter to Sankyo Pharma Inc. through its Division of Drug Marketing, Advertising and Communications (DDMAC). The letter requested that Sankyo immediately cease its promotion of certain sales and marketing materials that contained unsubstantiated effectiveness and superiority claims, and omitted or minimalized information on the risks associated with the use of Benicar.

Warning Letter to Benicar Manufacturer

In 2006, the U.S. Department of Health & Human Services (DOH) submitted a warning letter to Sankyo Pharma Inc. through its Division of Drug Marketing, Advertising and Communications (DDMAC). The letter requested that Sankyo immediately cease its promotion of certain sales and marketing materials that contained unsubstantiated effectiveness and superiority claims, and omitted or minimalized information on the risks associated with the use of Benicar.

The omitted or minimalized risk information included:

• Serious pregnancy-related risks
• Renal artery stenosis (narrowing of arteries that carry blood to one or both of the kidneys) precautions
• Risk information regarding the use of Benicar HCT in patients with impaired liver function or systemic lupus erythematosus (the most common form of lupus characterized by extreme fatigue and joint pain)
• Lithium interactions

In addition to the marketing warnings, Daiichi Sankyo faced kickback allegations. The U.S. Justice Department accused Daiichi Sankyo of paying doctors to prescribe Benicar. Daiichi Sankyo paid $39 million to settle the criminal case.

Benicar Facts

Please seek the advice of a medical professional before making health care decisions.

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Olmesartan (Benicar) for Hypertension | AAFP

KRISTINA E. WARD, PHARM.D., AND ANNE L. HUME, PHARM.D., B.C.P.S., University of Rhode Island College of Pharmacy, Kingston, Rhode Island

Am Fam Physician. 2005;72(4):673-674

Synopsis

Olmesartan (Benicar) is an angiotensin-II receptor blocker (ARB) labeled for the treatment of hypertension as monotherapy or in combination with other antihypertensive agents. Olmesartan blocks the binding of angiotensin II, a potent vasoconstrictor, to angiotensin type 1(AT₁) receptors located in vascular smooth muscle.¹

Safety

No serious safety issues were reported with olmesartan in clinical trials. The safety record of olmesartan was similar to placebo in seven randomized, double-blind, placebo-controlled phase II and III trials that included 2,540 patients with hypertension.² Adverse effects were reported in 42.2 percent and 42.7 percent of olmesartan-treated patients and placebo-treated patients, respectively. Olmesartan may cause hypotension and acute renal failure in patients who are sodium-or volume-depleted or whose renal perfusion is dependent on the renin-angiotensin system. Like all ARBs, olmesartan may precipitate acute renal failure in patients with renal artery stenosis. Significant hyperkalemia has not been reported with olmesartan, although it is possible, especially in patients with other risk factors for hyperkalemia. Of 3,825 patients treated with olmesartan during clinical trials, five reported angioedema.¹ It is not known whether patients who have developed angioedema with angiotensin-converting enzyme (ACE) inhibitors or other ARBs have an increased risk of developing this side effect with olmesartan. No dosage adjustments are needed in older patients or in patients with moderate to marked hepatic or renal impairment. As with other ARBs, olmesartan is U.S. Food and Drug Administration category C during the first trimester of pregnancy and category D during the second and third trimesters.¹ In rare instances, angioedema and rhabdomyolysis from olmesartan have been reported in postmarketing surveillance.¹

Tolerability

Olmesartan generally is well tolerated. In clinical trials, dizziness occurred in 2.8 percent of olmesartan-treated patients and in 0.9 percent of placebo-treated patients.² In a study³ comparing olmesartan to other ARBs, the incidence of dizziness was similar in olmesartan (1.4 percent), losartan (Cozaar; 0.7 percent), valsartan (Diovan; 1.4 percent), and irbesartan (Avapro; 3.4 percent). Headache was reported by 1.3 percent of patients receiving olmesartan and 2.5 percent receiving candesartan (Atacand).⁴ As with other ARBs, the incidence of cough with olmesartan is comparable to that with placebo (0. 9 and 0.7 percent, respectively).¹

Effectiveness

Short-term studies have shown that blood pressure control with olmesartan is similar to that achieved with other ARBs or amlodipine (Norvasc). Olmesartan in a dosage of 20 mg produces an average drop in diastolic blood pressure of 10 mm Hg and a comparable reduction in systolic blood pressure; this is in line with the reductions effected by equivalent dosages of other ARBs,^3,4 or a 5-mg dosage of amlodipine.⁵ Olmesartan has been studied in combination with hydrochlorothiazide (Esidrix) and has been found to produce an average additional diastolic blood pressure lowering of 7 to 10 mm Hg (with 20 mg or 40 mg olmesartan, respectively) compared with hydrochlorothiazide alone.⁶

Olmesartan has not been evaluated for the treatment of patients with heart failure or diabetic nephropathy. Although ARBs have been shown to decrease recurrent stroke in hypertensive patients,⁷ and mortality and morbidity in patients with hypertension accompanied by left ventricular hypertrophy,⁸ no studies have been performed to determine the effect of olmesartan on morbidity and mortality in patients with uncomplicated hypertension.

A one-month supply of Benicar in 20-mg tablets costs approximately $54, which is comparable to the price of other ARBs. Unlike other ARBs, however, the 5-mg, 20-mg, and 40-mg tablets of Benicar are similarly priced, which may be advantageous for self-paying patients.

Simplicity

The recommended starting dosage of olmesartan is 20 mg daily, taken with or without food. If blood pressure control is inadequate after two weeks, the dosage may be increased to a maximum of 40 mg daily. Dosages above 40 mg daily do not provide additional benefit. For patients who may be at risk for volume- or salt-depletion, such as those who have renal impairment and receive diuretics, a lower starting dosage is suggested. Olmesartan is available in 5-mg tablets if needed for dose reductions.

Bottom Line

Olmesartan is a safe and effective antihypertensive agent. There is no evidence that olmesartan is more effective than other ARBs or ACE inhibitors. The longest peer-reviewed studies of olmesartan are of two months’ duration; thus, there is no evidence showing olmesartan’s long-term benefit for cardiovascular or all-cause mortality. Because of its greater expense and lack of proven benefit over ACE inhibitors, olmesartan should be considered a second-line agent for hypertension except in patients who cannot tolerate ACE inhibitors.

STEPS new drug reviews cover Safety, Tolerability, Effectiveness, Price, and Simplicity. Each independent review is provided by authors who have no financial association with the drug manufacturer.

This series is coordinated by Allen F. Shaughnessy, PharmD, assistant medical editor.

A collection of STEPS published in AFP is available at https://www.aafp.org/afp/steps.

Top 5 best ACE inhibitors for effective treatment of hypertension

Content

• 1 Best ACE inhibitors
  • 1.1 Understanding ACE inhibitors
  • 1.2 Occurrence of hypertension
  • 1.3 Action of ACE inhibitors
  • 1.4 Benefits of using ACE inhibitors
  • 1.5 Main indications to the use of ACE inhibitors
  • 1. 6 Top-5 best ACE inhibitors
  • 1.7 Ramipril
  • 1.8 Losartan
  • 1.9Enalapril
  • 1.10 Related videos:
  • 1.11 Q&A:
    • • 1.11.0.1 Which ACE inhibitors are on the top 5 list?
      • 1.11.0.2 How do ACE inhibitors work in the treatment of hypertension?

The best angiotensin converting enzyme (ACE) inhibitors will become an indispensable tool for the treatment of hypertension and cardiovascular diseases. Review the list of drugs that block ACE and provide effective blood pressure regulation and protection of organs from damage.

Hypertension is a serious disease that requires comprehensive and effective treatment. ACE inhibitors are one of the most effective treatments for high blood pressure. They help reduce blood pressure, improve heart function and prevent the development of complications.

Here are the top 5 best ACE inhibitors that can be used to effectively treat hypertension:

1. Enap is a powerful ACE inhibitor that has a long-lasting effect. It effectively lowers blood pressure and improves blood circulation. The drug has low toxicity and is well tolerated by patients.
2. Captopril is a drug that is actively used to treat hypertension. It reduces vascular resistance, improves heart function and prevents the development of cardiovascular complications.
3. Lisinopril – This ACE inhibitor shows excellent results in the treatment of hypertension. It effectively lowers blood pressure, and also improves endothelial function and prevents the development of atherosclerosis.
4. Ramipril is a drug that allows you to achieve a stable reduction in blood pressure. It improves blood circulation, normalizes the work of the heart and prevents the development of left ventricular hypertrophy.
5. Perindopril – This ACE inhibitor is highly effective in the treatment of hypertension. It reduces blood pressure, improves kidney function and prevents the development of kidney failure.

The choice of an ACE inhibitor for the treatment of hypertension depends on the individual patient and the presence of comorbidities. Before you start taking any drug, be sure to consult your doctor.

Keep in mind that regular blood pressure monitoring and the use of recommended ACE inhibitors will help maintain cardiovascular health and prevent the complications of hypertension.

Understanding ACE inhibitors

Angiotensin-converting enzyme (ACE) inhibitors are a class of drugs used in the treatment of hypertension, heart failure, and other cardiovascular diseases. They work by blocking the action of ACE, which leads to a decrease in angiotensin II and vasodilation, which in turn reduces pressure in the blood vessels.

There are many ACE inhibitors, but some of the most effective and popular include lisinopril, enalapril, quinapril, ramipril, and perindopril. These drugs are well tolerated and safe, and studies show that they reduce the risk of developing cardiovascular complications.

When choosing an ACE inhibitor, the individual patient and the presence of comorbidities must be taken into account. It is important to consult with your doctor so that he prescribes the most suitable drug and the correct dosage.

Based on all the important information above, the general conclusion is that ACE inhibitors are effective drugs used to treat hypertension and other cardiovascular diseases. They have numerous benefits and are well tolerated by patients. If you have symptoms of hypertension or other related conditions, contact your doctor to learn more about ACE inhibitor treatment options.

The onset of hypertension

Hypertension, or high blood pressure, is one of the most common medical conditions in the world today. Its occurrence is associated with a number of factors, including genetic predisposition, unhealthy diet, sedentary lifestyle, excess weight and stress.

One effective treatment for hypertension is the use of angiotensin-converting enzyme (ACE) inhibitors. These drugs act on blood pressure regulation mechanisms by blocking the action of angiotensin-converting enzyme, which is involved in arterial narrowing.

Here is a list of the top five ACE inhibitors for effective treatment of hypertension:

1. Lisinopril: An effective and well-tolerated drug that lowers blood pressure and prevents organ damage.
2. Enalapril: has a pronounced antihypertensive effect, improves the contractile function of the heart and reduces the load on it.
3. Ramipril: has a pronounced cardioprotective effect, reduces the likelihood of developing cardiovascular complications.
4. Perindopril: improves microcirculation, reduces peripheral vascular resistance and exhibits cardioprotective and vasodilating effects.
5. Quinapril: effectively lowers blood pressure, slows the progression of left ventricular hypertrophy and prevents the development of cardiovascular complications.

Action of ACE inhibitors

ACE (angiotensin converting enzyme) inhibitors are a class of drugs used to effectively treat hypertension. They work by blocking the action of an enzyme that normally converts angiotensin I to angiotensin II. This reduces the contraction of blood vessels and the level of angiotensin II in the body, which leads to a decrease in blood pressure.

ACE inhibitors are one of the most effective treatments for hypertension and have several beneficial properties. First, they improve vascular function and reduce blood flow resistance, which helps lower blood pressure. In addition, ACE inhibitors may protect the kidneys by preventing glomerular damage and fluid retention in the body.

In general, ACE inhibitors are a powerful treatment for hypertension and can have positive effects on the heart, blood vessels, and kidneys. However, before starting the use of these drugs, it is necessary to consult a medical specialist and evaluate possible contraindications and side effects.

Benefits of using ACE inhibitors

Angiotensin converting enzyme (ACE) inhibitors are one of the most effective drug groups for treating hypertension. They have a positive effect on the cardiovascular system and have several advantages over other drug classes.

Low number of side effects

ACE inhibitors are well tolerated and rarely cause side effects. They do not adversely affect kidney function and do not cause drowsiness, nausea, or dizziness. This makes them an ideal choice for patients with unstable health or dental health problems.

Compatibility with other drugs

ACE inhibitors can be successfully combined with other drug groups such as diuretics or beta-blockers. This allows you to achieve the best control over blood pressure and reduce the risk of complications of hypertension.

Prevention of the progression of left ventricular hypertrophy

Studies have shown that ACE inhibitors can slow or stop the progression of left ventricular hypertrophy. This condition is one of the major risk factors for developing heart failure, and preventing its progression plays an important role in the management of hypertension.

Kidney protection

ACE inhibitors have a protective effect on the renal vessels, which may reduce the risk of developing chronic renal failure. They help maintain normal blood flow to the kidneys and prevent damage to kidney structures.

Reducing the risk of myocardial infarction and stroke

ACE inhibitors reduce the risk of heart stroke and myocardial infarction in patients with hypertension. They reduce platelet aggregation and improve microcirculation, which helps to reduce the risk of blood clots and the development of cardiovascular complications.

Based on these benefits, ACE inhibitors are the best choice for treating hypertension and preventing its complications. They will help control blood pressure, protect target organs and improve the quality of life of patients.

Main indications for the use of ACE inhibitors

1. Hypertension: ACE inhibitors are one of the main drugs used to treat hypertension or high blood pressure. They help to reduce the contractile activity of blood vessels, improve blood circulation and reduce pressure on the walls of the arteries.

2. Chronic heart failure: ACE inhibitors are also commonly used to treat chronic heart failure. They reduce the load on the heart, improve its contractile function and prevent the development of complications.

3. Prevention of kidney damage: In patients with diabetes mellitus or chronic kidney disease, ACE inhibitors may be used to prevent kidney damage and slow the progression of the disease.

4. Stroke prevention: If risk factors for stroke such as high blood pressure or diabetes are present, ACE inhibitors may be recommended to prevent this serious complication.

5. Diabetic Nephropathy: ACE inhibitors may be used to treat diabetic nephropathy, a complication of diabetes that causes kidney damage. They can slow the progression of the disease and reduce the risk of major complications.

ACE inhibitors are reliable and effective drugs for the treatment of various conditions associated with high blood pressure and cardiovascular disease. However, before you start taking ACE inhibitors, you should consult your doctor and read the instructions for use.

Top 5 best ACE inhibitors

Hypertension or high blood pressure is a serious problem for many people. However, there is an effective way to control blood pressure and prevent the development of complications – the use of ACE inhibitors.

Among the many ACE inhibitors on the market, the top 5 most effective and safe drugs can be distinguished:

1. Losartan. This ACE inhibitor shows excellent results in lowering blood pressure and preventing the development of cardiovascular complications. It is also effective in treating kidney failure.
2. Enalapril. Is one of the most popular ACE inhibitors. It lowers blood pressure, improves heart function and reduces the risk of myocardial infarction and stroke.
3. Perindopril. Helps control blood pressure, prevents vascular damage and improves heart function.
4. Ramipril. An ACE inhibitor that effectively lowers blood pressure and prevents the development of cardiovascular complications.
5. Quinapril This drug not only lowers blood pressure, but also improves heart function, prevents complications and improves the patient’s quality of life.

It is important to understand that the choice of an ACE inhibitor should only be made on the advice of a physician, as each drug has its own characteristics and may not be suitable for a particular patient. However, the top 5 ACE inhibitors described above are reliable and time-tested drugs that can help control hypertension and prevent cardiovascular complications.

Ramipril

Ramipril is one of the most effective ACE inhibitors used to treat hypertension. The drug does an excellent job of normalizing blood pressure and improving heart function. It blocks the action of the angiotensin-converting enzyme, which leads to vasodilation and a decrease in blood flow resistance.

The advantages of ramipril are that it is highly effective and well tolerated by the body. The drug not only lowers blood pressure, but also reduces the load on the heart, which is especially important for patients with heart failure. Ramipril prevents the progression of hypertension and reduces the risk of cardiovascular complications.

Ramipril is taken by mouth once a day. The dosage is prescribed by the doctor individually, based on the characteristics of the patient and the degree of hypertension. The drug is easily tolerated by the body, but it is necessary to follow the doctor’s recommendations for dosage and regularity of administration.

It is important to remember that ramipril is a drug and should only be used as directed by a doctor. Reception must be carried out under constant medical supervision in order to achieve maximum efficiency and safety for the patient.

Losartan

Losartan is a highly effective ACE inhibitor that is widely used in the treatment of hypertension. Its mechanism of action is to block the action of angiotensin II, which is a powerful vasoconstrictor and blood pressure factor.

The advantages of losartan include its good tolerability and low incidence of side effects. In addition, losartan effectively lowers blood pressure both at rest and during exercise.

For greater ease of use, losartan is available in a variety of tablet strengths, allowing you to choose the most appropriate for each patient. Also, losartan can be used in combination with other drugs to achieve the best results in the treatment of hypertension.

It is important to note that losartan is a prescription drug and must be used under medical supervision. Failure to comply with recommendations on dosage and frequency of administration may lead to a decrease in the effectiveness of treatment and the occurrence of side effects.

So, losartan is one of the best ACE inhibitors for the effective treatment of hypertension. Its mechanism of action, high tolerability and convenient formulation make it an excellent choice for patients suffering from high blood pressure. However, before you start taking losartan, you should consult with your doctor.

Enalapril

Enalapril is one of the best ACE inhibitors for effective treatment of hypertension. It belongs to a class of drugs that help lower blood pressure and prevent the development of cardiovascular disease.

The active substance of the drug is enalapril, which is an angiotensin-converting enzyme (ACE) inhibitor. It is an important enzyme that plays a key role in the regulation of blood pressure. Enalapril blocks the action of ACE, which leads to vasodilation and a decrease in pressure.

The advantages of enalapril include its long duration of action and good patient tolerance. It effectively lowers blood pressure and improves heart function. Enalapril may also be given in combination with other antihypertensive drugs to achieve optimal pressure control.

It is important to note that enalapril is a drug and should only be taken with a doctor’s prescription. Taking the drug should be accompanied by regular monitoring of blood pressure and following the doctor’s recommendations. Talk to your doctor to learn more about using enalapril to treat your hypertension.

Related videos:

Q&A:

What are the top 5 ACE inhibitors?

The top 5 best ACE inhibitors for effective treatment of hypertension include the following drugs: lisinopril, enalapril, captopril, ramipril, perindopril.

How do ACE inhibitors work in the treatment of hypertension?

ACE inhibitors (angiotensin converting enzyme) help lower blood pressure by blocking the action of angiotensin II, which leads to vasodilation and decreased peripheral arterial resistance. They also improve endothelial function, reduce proteinuria and have anti-inflammatory properties.

New in cardiology | Online publication “Medicine and Pharmacy News”

The risk of coronary artery disease in patients who have had a stroke or transient ischemic attack (Data from the SPARCL study)

It is known that non-coronary forms of atherosclerosis (transient ischemic attack (TIA) carotid arteries, or only the presence of more than 50% carotid stenosis) is associated with an increased risk of complications – the same as in coronary atherosclerosis – more than 20% in the next 10 years. The SPARCL (Stroke Prevention by Aggressive Reduction in Cholesterol Levels) study included patients who had a stroke or TIA and did not have data on the presence of coronary artery disease at the time of inclusion. A total of 4731 patients (mean age 63 years) were included in the study who were randomized to receive either atorvastatin 80 mg/day or placebo. The incidence of major coronary events, any cardiovascular events, and any revascularization procedures were assessed. After 4.9year of follow-up, the risk of developing coronary events and any cardiovascular events in the placebo group was 5.1% and 8.6%, respectively. Over time, the risk of stroke increased, while the risk of coronary events remained stable. When comparing the subgroup of patients who suffered ischemic stroke as a result of atherosclerotic lesions of large cerebral arteries and the subgroup with other lesions (TIA, stroke due to small vessels, hemorrhagic stroke), there were no differences in the incidence of coronary events or any cardiovascular events. However, in the subgroup of patients who had a TIA, small vessel disease, or stroke of unknown etiology, the frequency of revascularization procedures was lower. Major coronary events, all CV events, and revascularization procedures all decreased equally with atorvastatin but not with placebo, regardless of stroke subtype.

Thus, the risk of coronary complications is significantly reduced under the influence of atorvastatin therapy in patients who have had a stroke or TIA, regardless of stroke subtype.

(Amaraengo P., Goldstein L., Sillesen H. et al. Corenary Heart Disiase Risk in patients with Stroke or Transient Ischemic Attack and No Known Coronary Heart Disease. Findings From the Storke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL ) Trial // Stroke. – 2010, Jan( in press)

Angiotensin receptor blocker use and dementia risk in the male population: results from a prospective cohort analysis

The aim of the study was to evaluate whether angiotensin II receptor blockers (ARBs) could prevent or reduce the progression of Alzheimer’s disease and dementia.

The study included 819,491 people (98% male) aged 65 years (mean 74 years) and older with cardiovascular disease who were covered by the Veteran’s Care System. Based on the entry in the medical database, all patients were divided into 3 groups: the group receiving ARBs, the group receiving lisinopril, the group not receiving renin-angiotensin system blockers (comparison group). Disease progression was assessed by the time of admission to a nursing home or the onset of death among individuals with Alzheimer’s disease or dementia. The mean follow-up period was 4 years.

The incidence of dementia in the ARB group was 24% lower (OR = 0.76, CI 0.69-0.84) compared to the control group and 19% (OR = 0.81, CI 0.73-0.84) 0.90) compared with the lisinopril group. Patients with pre-existing Alzheimer’s disease had a significantly lower risk of nursing home admission (OR = 0.51, CI 0.36–0.72) and death (OR = 0.83, CI 0.71–0.97) at ARB group compared to the comparison group. A dose-dependent effect of ARB administration was observed, as well as an additional positive effect with the combination of ARB and ACE inhibitors. When comparing the combination of ARB + ​​ACE inhibitor, the risk of dementia was 46% less, admission to the nursing home was 67% less than in the ACE inhibitor alone group. Differences in blood pressure levels were minimal.

Thus, in a predominantly male population, ARBs were associated with a significant reduction in the incidence and progression of Alzheimer’s disease and dementia compared with treatment with ACE inhibitors and other cardiovascular drugs.

(Li N., Lee A., Whitmer R. et al. Use of angoitensin receptor blockers and risk of mentia in predominantly male population: prospective cohort analysis // BMJ. — 2010 (online first))

Uncontrolled arterial hypertension is associated with a large amount of damage to the white matter of the brain

The results of the Women’s Health Initiative (WHI) Memory Study (WHIMS), which included women aged 65 years and older who were tested for dementia (Mini-Mental Test), have been published. Those women who had a score of 80% or less in eighth grade education and 88% or less in higher education received an additional comprehensive neuropsychological examination. A subset of women (aged 70 years and older) participated in the WHIMS-MRI substudy and underwent magnetic resonance imaging (MRI). They were subsequently randomized to receive active hormonal therapy (conjugated equine estrogen (CLE) or a combination of CLE with medroxyprogesterone acetate – MPA) or placebo. MRI was performed not at the beginning of the study, but approximately 8 years after randomization. The last MRI was performed on average after 3 years of combined hormonal therapy and 1.3 years after treatment with CLE alone.

The primary endpoint of the study was the measurement of total white matter lesion volume in cubic centimeters.

Of the 2345 women who were asked to participate in the WHIMS-MRI study, 72% agreed to be screened. The results of examination of 1403 patients were included in the analysis. Of these, 883 were randomized to receive combination hormonal therapy (436 to active therapy and 447 to placebo) and 520 to CLE alone (257 to active therapy and 263 to placebo).

At the time of the MRI, the average age of the women was 78.5 years. At baseline, 31% of women had a SBP of 140 mm Hg. and above, almost one-third were not taking antihypertensive therapy. Only 57% of those taking antihypertensive drugs had SBP less than 140 mmHg. Baseline SBP was significantly associated with the volume of white matter lesions. At the same time, there were no differences in the groups receiving combined and monohormonal therapy.

When BP was later measured, 47% of the women were on antihypertensive therapy and BP was controlled in two-thirds of the patients. At the same time, the volume of white matter lesions depended on the level of blood pressure in the group of women who did not receive antihypertensive therapy, but not in the group who received antihypertensive treatment.

Investigators stated that they found no difference between groups of untreated women with normal BP and treated women with BP less than 140/90 mmHg. by the volume of the lesion, by the number of regions with lesions of the white matter and by the lesion of the basal ganglia. This made it possible to say that BP control reduces the negative effect of arterial hypertension on the white matter of the brain, and made it possible to recommend to young and middle-aged women to maintain the level of BP as low as possible to prevent the development of dementia and stroke.

( Kuller L Clinical Hypertension – 2010 ( published online ))*

Raising children helps lower blood pressure

The study included 198 adults who were subjected to BP monitoring using a portable device hidden under clothing. All participants were married and in good health. Age ranged from 20 to 68 years. 70% of participants had children (mean 1.9child), 80.6% were white with a median education of 16 years.

Blood pressure was monitored throughout the day. The analysis of monitoring data was carried out by an independent specialist.

As a result, it turned out that in couples who had children, the level of blood pressure was significantly lower than in couples who did not have children. This difference was especially large in women.

Thus, the data obtained may indicate that fatherhood, and especially motherhood, may have a cardioprotective effect.

(Holt-Lunstad J. et al. Married With Children: The Influence of Parental Status and Gender on Ambulatory Blood Pressure // Annals of Behavioral Medicine. – 2010, February (published online)) benicar (olmesartan) for the treatment of high blood pressure in children and adolescents aged 6-16 years

Daiichi Sankyo, Inc. announced that the FDA has approved the use of the drug benicar (olmesartan medoxomil) for the treatment of arterial hypertension (AH) in children and adolescents aged 6 to 16 years. For the treatment of hypertension in adults, this drug was approved in 2002.

Approximately 5%, or 3.6 million, of children in the United States have high blood pressure (BP), and most are unaware of it. A number of studies have shown that increased blood pressure is associated with being overweight. Especially increased the prevalence of high blood pressure among children after the 80s.

The problem of hypertension in children is closely related to obesity: obese children have a 3 times higher risk of developing hypertension compared to children who are not obese. In addition, the presence of elevated blood pressure in childhood is an independent risk factor for hypertension in adulthood, associated with early markers of cardiovascular disease, which makes it necessary to treat these conditions in childhood and adolescence.

Approval of new indications for the use of benicar became possible after the results of the 3rd phase study of the antihypertensive efficacy of olmesartan in children with elevated blood pressure. This study demonstrated the safety and efficacy of olmesaratan in children aged 6 to 16 years compared with placebo. The tolerability of olmesartan in children was comparable to that in adults. This drug is recommended for use in children as initial therapy.

Blood pressure diet is more effective when used in combination with other lifestyle interventions

In a study by J.A. Blumenthal et al conducted a lifestyle modification study on blood pressure (BP) levels in 144 obese patients. For 4 months, 46 patients were on a Dietary Approaches to Stop Hypertension (DASH) diet to reduce blood pressure, 49 along with the diet performed special physical and cognitive-behavioral exercises aimed at weight loss, 49 were on their usual diet.

Blood pressure level decreased by 16.1/9.9 mmHg in those who were on a diet and performed weight loss exercises, by 11.2/7.5 mm Hg. – in those who were only on a diet, and by 3.4 / 3.8 mm Hg. – those who did not change their lifestyle. In addition, there was a significant improvement in the state of blood vessels and a decrease in the mass of the left ventricular myocardium in the group of patients who took a comprehensive approach to lifestyle changes.

Data from the present study showed that the DASH diet, especially when combined with exercise and weight loss, can not only contribute to a significant decrease in blood pressure, but also affect markers of the risk of cardiovascular complications.

(Arch. Intern. Med. – 2010. – Vol. 170 – R. 126-135)

Central arterial pressure is better than peripheral, determines the development of left ventricular hypertrophy

In the journal J. hypertens. published the results of a study in which the Sphygmo Cor® device non-invasively assessed central arterial pressure (BP). It turned out that central blood pressure is a more important factor in the development of left ventricular hypertrophy (LVH) than pressure measured at the shoulder.

This study included data from 2585 participants in the Strong Heart study. 60% of the participants were female, 21% had diabetes, and 33% had high blood pressure. The level of both blood pressure measured at the shoulder and central blood pressure significantly correlated with the mass index of the left ventricular myocardium, wall thickness, and diastolic diameter of the left ventricle. However, relative wall thickening and myocardial mass index were more associated with central BP. In addition, systolic blood pressure had a greater influence on the formation of concentric LVH than pulse and diastolic blood pressure. Pulse BP was more associated with the development of vessel wall thickening and atherosclerosis.

LVH is a major risk factor for heart failure, coronary events and stroke. Measurement of central BP is an obvious and vital necessity for identifying high-risk patients, effectively treating hypertension, and determining the positive impact of lifestyle modification.

(Roman M . et al. Relations of central and brachial blood pressure to left ventricular hypertrophy and geometry: the Strong Heart Study // Journal of Hypertension. – 2010. – Vol. 28. – R . 384-388)

Beta-blockers reduce pulse pressure less than diuretics

It is generally accepted that all classes of antihypertensive drugs reduce blood pressure (BP) equally. However, J. Chen et al argue that this is not the case. They analyzed 20 double-blind, randomized controlled trials comparing beta-blockers (BAB) in combination with other antihypertensive drugs with the same drugs used as monotherapy. The duration of these studies ranged from 3 to 12 weeks. The number of included patients was 3744 people with essential arterial hypertension. Studies in which β-blockers were combined with ACE inhibitors or AII receptor blockers were not included.

The aim of the study was to determine the effect of BB as second-line drugs on the level of systolic (SBP), diastolic (DBP) blood pressure, heart rate and the development of side effects.

A decrease in blood pressure has been observed when β-blockers were added to thiazide diuretics or calcium antagonists at a dose greater than 1/4 of the manufacturer’s recommended starting dose. The level of SBP/DBP decreased by 6/4 mm Hg when β-blockers were administered at the initial dose, and by 8/6 mm Hg when the initial dose of β-blockers was doubled.

When the antihypertensive effect of β-blockers was compared with that of diuretics, it turned out that β-blockers have little effect on the level of pulse BP, while thiazides reduce the level of pulse BP in a dose-dependent manner. Perhaps, according to the authors, this can explain the difference in the effect of diuretics and beta-blockers on the incidence of cardiovascular events in elderly patients, in whom pulsed BP is a more powerful risk factor. Therefore, the authors recommend the use of diuretics in elderly patients as first-line drugs, which are highly effective and cheaper. If, for some reason, it is impossible to give thiazides as a first-line drug, then they should be prescribed as second-line drugs.

(Chen J., Heran B., Perez M. et al. Blood pressure lowering efficacy of beta-blockers as second-line therapy for primary hypertension // Cochrane Database Sys. Rev. 2010. – 1. – CD007185)

The record study confirmed an increased risk of heart failure with rosiglitazone therapy

heart failure increases with the use of rosiglitazone, regardless of whether it was added to metformin or sulfonylurea therapy.

The study included 4447 patients with type 2 diabetes mellitus (age 40 to 75 years, HbA1c 7-9%, body mass index greater than 25 kg/m2) who were randomized to receive either rosiglitazone (in combination with metformin). or sulfonylurea), or a combination of metformin + sulfonylurea. Rosiglitazone was given at an initial dose of 4 mg/day and increased to 8 mg/day after 8 weeks. A third drug was added if the HbA1c level remained above 8.5%. If the third drug was ineffective, then insulin was prescribed.

The incidence of hospitalizations for cardiovascular causes or death reached 14.5% in both groups during 5.5 years of follow-up. There were no significant differences in the incidence of cardiovascular death, myocardial infarction or stroke. The incidence of myocardial infarction was 14% non-significantly higher in the rosiglitazone group than in the control group, which led some researchers to argue that rosiglitazone increases the incidence of myocardial infarction.

In the present secondary analysis, the incidence of fatal and non-fatal events associated with heart failure was 2-fold higher in the rosiglitazone group (HR = 2.1; CI 1.35–3.27). The estimated occurrence of events associated with heart failure was 2. 6 per 1000 patients per year. At the same time, there was no increase in the risk of cardiovascular mortality or hospitalizations. The main predictors of events associated with heart failure were age (HR = 1.1), increased body mass index (HR = 1.11), elevated urine albumin/creatinine ratio (HR = 2.95), taking rosiglitazone (HR = 2.34), elevated systolic blood pressure (HR = 1.66), but no history of cardiovascular disease.

(Komajda M., McMurray J., Beck-Nielsen H. et al. Heart failure events with rosiglitazone in type 2 diabetes: data from the RECORD clinical trial // Eur.Heart. J. – 2010. – DOI: 10.1093/eurheartj/ehp604)

The use of beta-blockers is associated with the development of cataracts

Australian researchers G. Kanthan et al studied the association between the use of antihypertensive drugs and the long-term risk of cataracts in elderly patients. They found that there was a borderline increase in the incidence of nuclear cataracts with the use of beta-blockers and calcium antagonists.