Olmesartan Medoxomil-Based Antihypertensive Therapy Evaluated by Ambulatory Blood Pressure Monitoring: Efficacy in High-Risk Patient Subgroups

Olmesartan Medoxomil-Based Antihypertensive Therapy Evaluated by Ambulatory Blood Pressure Monitoring: Efficacy in High-Risk Patient Subgroups Authors: Chrysant, Steven G.1; Germino, F. Wilford2; Neutel, Joel M.3 Source: American Journal of Cardiovascular Drugs, Volume 12, Number 6, 1 December 2012 , pp. 375-389(15) Publisher: Adis International Abstract: Hypertension affects approximately 26% of the world's adult population and is a recognized major risk factor for morbidity and mortality associated with cardiovascular, cerebrovascular, and renal diseases. However, despite the availability of a range of effective antihypertensive agents and a growing awareness of the consequences of high blood pressure (BP), the treatment and control of hypertension remains suboptimal. A number of patient subgroups are categorized as `high risk' and may have hypertension that is more difficult to treat, including obese individuals, patients with stage 2 hypertension, those with type 2 diabetes mellitus (T2DM), patients with coronary artery disease or a history of stroke, and Black patients. As the benefits of lowering BP in patients with hypertension are unequivocal, particularly in high-risk patients, treating high-risk patients with hypertension to BP goals and maintaining 24-hour BP control is important to help reduce cardiovascular risk and improve outcomes. Although the BP goals recommended in current consensus guidelines for the management of patients with hypertension are based on cuff BP measurements, ambulatory BP monitoring (ABPM) provides a valuable diagnostic tool and allows a more accurate assessment of BP levels throughout the 24-hour dosing period. ABPM is a better predictor of prognosis than office BP measurement and is also useful for assessing whether antihypertensive therapy remains effective in the critical last few hours of the dosing period, which usually coincides with the morning BP surge associated with arousal and arising. ABPM has been adopted by new evidence-based guidelines in the United Kingdom to confirm a suspected diagnosis of hypertension, which is an indication of the growing importance of ABPM in the management of hypertension. This review provides an overview of the efficacy and safety of antihypertensive therapy based on olmesartan medoxomil ± hydrochlorothiazide and amlodipine/olmesartan medoxomil in high-risk patient populations enrolled in studies that reported ambulatory BP endpoints. The studies identified in this review showed that a titrate-to-BP goal strategy using olmesartan medoxomil- or amlodipine/olmesartan medoxomil-based antihypertensive therapy was an effective and well-tolerated approach for maintaining BP control throughout the full 24-hour dosing period in high-risk patients with difficult-to-treat hypertension.

Statins may lower the risk of esophageal cancer

THURSDAY, June 6 (HealthDay News) -- Statins may lower the risk of esophageal cancer, particularly in patients with Barrett's esophagus, according to a review published in the June issue of Clinical Gastroenterology and Hepatology. Siddharth Singh, MD, from the Mayo Clinic in Rochester, MN, and colleagues conducted a literature review through August 2012 to identify 13 studies that evaluated exposure to statins, reported the development of esophageal cancer, and reported relative risks or odds ratios (OR) or provided data for their estimation. The researchers found that the included studies reported 9,285 cases of esophageal cancer among 1,132,969 patients. A significant (28 percent) reduction in the risk of esophageal cancer was seen among patients who took statins (adjusted OR, 0.72), in a meta-analysis, although there was considerable heterogeneity among studies. Among a subset of patients known to have Barrett's esophagus (five studies; 312 esophageal adenocarcinomas [EACs] in 2,125 patients), after adjusting for potential confounders, statins were associated with a significant (41 percent) decrease in the risk of EAC, (adjusted OR, 0.59). To prevent one case of EAC in patients with Barrett's esophagus, the number needed to treat with statins was 389. "Based on meta-analysis of observational studies, statin use may be associated with lower risk of esophageal cancer, partic