Clinical Drug Investigation

, Volume 26, Issue 4, pp 185–193

Antihypertensive Efficacy of Olmesartan Medoxomil and Candesartan Cilexetil in Achieving 24-Hour Blood Pressure Reductions and Ambulatory Blood Pressure Goals

Original Research Article


Background: For patients with hypertension, effective 24-hour blood pressure (BP) control is vital to ensure protection against the early morning surge in BP and the associated increased risk of cardiovascular events. The aim of this analysis was to assess the 24-hour antihypertensive efficacy of olmesartan medoxomil (20mg once daily) compared with candesartan cilexetil (8mg once daily), with particular emphasis on BP control during the early morning period.

Methods: This is an additional analysis of a previously reported randomised, double-blind study in which 635 patients with mainly mild to moderate hypertension were randomised to 8 weeks of treatment with either olmesartan medoxomil 20 mg/day or candesartan cilexetil 8 mg/day. Changes from baseline during the last 4 and 2 hours of ambulatory BP measurement (ABPM) after 1, 2 and 8 weeks of treatment were compared between the two groups. In addition, the proportions of patients who achieved various ABPM goals, including those suggested by the European Society of Hypertension/European Society of Cardiology (ESH/ESC) [<125/80mm Hg] and the Japanese Society of Hypertension (JSH) [<135/80mm Hg], over 24 hours, during the daytime and at the last 4 and 2 hours of ABPM measurement were also compared.

Results: After 8 weeks, significantly greater proportions of patients treated with olmesartan medoxomil 20mg achieved 24-hour and daytime ABPM goals recommended by the guidelines of the ESH/ESC (25.6% and 18.3%, respectively) and JSH (37.5% and 26.6%, respectively) compared with candesartan cilexetil 8mg (24-hour ESH/ESC goal = 14.9%, p < 0.001; 24-hour JSH goal = 26.6%, p = 0.003; daytime ESH/ESC goal = 9.6%, p = 0.002; daytime JSH goal = 16.4%, p = 0.002). During the last 4 hours of 24-hour ABPM, the proportions of patients who achieved the ESH/ESC and JSH ABPM goals were significantly greater with olmesartan medoxomil (33.3% and 39.1%, respectively) than with candesartan cilexetil (22.9%, p < 0.001 and 31.6%, p = 0.047, respectively). Similarly, during the last 2 hours of 24-hour ABPM, the proportions of patients who achieved these BP goals were either significantly greater (JSH) or approached statistical significance (ESH/ESC) with olmesartan medoxomil (26.9% and 19.9%, respectively) compared with candesartan cilexetil (19.6%, p = 0.028 and 14.3%, p = 0.061, respectively).

Conclusion: Compared with candesartan cilexetil 8mg, greater proportions of olmesartan medoxomil-treated patients (20mg) achieved ESH/ESC and JSH ABPM goals over 24 hours. The superior BP control of olmesartan medoxomil was also reflected in the larger proportions of olmesartan medoxomil-treated patients who achieved the ESH/ESC and JSH ABPM goals during the early morning surge period. This not only demonstrates that olmesartan medoxomil 20mg provides superior 24-hour BP reduction, but also suggests that olmesartan medoxomil may provide greater protection against the increased risk of cardiovascular events associated with the early morning BP surge period.


  1. 1.
    Ezzati M, Lopez AD, Rodgers A, et al. Selected major risk factors and global and regional burden of disease. Lancet 2002; 360: 1347–60PubMedCrossRefGoogle Scholar
  2. 2.
    Kannel WB. Blood pressure as a cardiovascular risk factor: prevention and treatment. JAMA 1996; 275: 1571–6PubMedCrossRefGoogle Scholar
  3. 3.
    World Health Organization. The World Health Report, 2002Google Scholar
  4. 4.
    White WB. Orcadian variation of blood pressure: clinical relevance and implications for cardiovascular chronotherapeutics. Blood Press Monit 1997; 2: 47–51PubMedGoogle Scholar
  5. 5.
    Millar-Craig MW, CN Bishop, Raftery EB. Orcadian variation of blood-pressure. Lancet 1978; I: 795–7CrossRefGoogle Scholar
  6. 6.
    Anwar YA, White WB. Chronotherapeutics for cardiovascular disease. Drugs 1998; 55: 631–43PubMedCrossRefGoogle Scholar
  7. 7.
    White WB. Cardiovascular risk and therapeutic intervention for the early morning surge in blood pressure and heart rate. Blood Press Monit 2001; 6: 63–72PubMedCrossRefGoogle Scholar
  8. 8.
    Neal B, MacMahon S, Chapman N. Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomised trials. Blood Pressure Lowering Treatment Trialists’ Collaboration. Lancet 2000; 356: 1955–64PubMedCrossRefGoogle Scholar
  9. 9.
    UKPDS. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group. BMJ 1998; 317: 703–13CrossRefGoogle Scholar
  10. 10.
    Dahlof B, Sever PS, Poulter NR, et al. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet 2005; 366: 895–906PubMedCrossRefGoogle Scholar
  11. 11.
    European Society of Hypertension-European Society of Cardiology. 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003; 21: 1011–53CrossRefGoogle Scholar
  12. 12.
    Guidelines Committee, Japanese Society of Hypertension. 2004 Guidelines for the management of hypertension (in Japanese). Life Science Publishing Co., Ltd 2004Google Scholar
  13. 13.
    Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289: 2560–72PubMedCrossRefGoogle Scholar
  14. 14.
    McGrath BP. Is white-coat hypertension innocent? [Letter]. Lancet 1996; 348: 630PubMedCrossRefGoogle Scholar
  15. 15.
    Clement DL, De Buyzere ML, De Bacquer DA, et al. Prognostic value of ambulatory blood-pressure recordings in patients with treated hypertension. N Engl J Med 2003; 348: 2407–15PubMedCrossRefGoogle Scholar
  16. 16.
    Staessen JA, Thijs L, Fagard R, et al. Predicting cardiovascular risk using conventional vs ambulatory blood pressure in older patients with systolic hypertension. Systolic Hypertension in Europe Trial Investigators. JAMA 1999; 282: 539–46PubMedCrossRefGoogle Scholar
  17. 17.
    Mancia G, Parati G. Office compared with ambulatory blood pressure in assessing response to antihypertensive treatment: a meta-analysis. J Hypertens 2004; 22: 435–45PubMedCrossRefGoogle Scholar
  18. 18.
    Brunner HR, Stumpe KO, Januszewicz A. Antihypertensive efficacy of olmesartan medoxomil and candesartan cilexetil assessed by 24-hour ambulatory blood pressure monitoring in patients with essential hypertension. Clin Drug Invest 2003; 23: 419–30CrossRefGoogle Scholar
  19. 19.
    Oparil, S, Williams D, Chrysant SG, et al. Comparative efficacy of olmesartan, losartan, valsartan, and irbesartan in the control of essential hypertension. J Clin Hypertens 2001; 3: 283–91, 318Google Scholar
  20. 20.
    Arakawa K. Significance of suppressing angiotensin by ARB [in Japanese, with abstract in English]. Progr Med 2004; 24: 1757–62Google Scholar
  21. 21.
    Muller JE, Stone PH, Turi ZG, et al. Circadian variation in the frequency of onset of acute myocardial infarction. N Engl J Med 1985; 313: 1315–22PubMedCrossRefGoogle Scholar
  22. 22.
    Willich SN, Levy D, Rocco MB, et al. Circadian variation in the incidence of sudden cardiac death in the Framingham Heart Study population. Am J Cardiol 1987; 60: 801–6PubMedCrossRefGoogle Scholar
  23. 23.
    Smith DH, Dubiel R, Jones M. Use of 24-hour ambulatory blood pressure monitoring to assess antihypertensive efficacy: a comparison of olmesartan medoxomil, losartan potassium, valsartan, and irbesartan. Am J Cardiovasc Drugs 2005; 5: 41–50PubMedCrossRefGoogle Scholar
  24. 24.
    Hansson L, Zanchetti A, Carruthers SG, et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet 1998; 351: 1755–62PubMedCrossRefGoogle Scholar
  25. 25.
    Weber MA, Julius S, Kjeldsen SE, et al. Blood pressure dependent and independent effects of antihypertensive treatment on clinical events in the VALUE trial. Lancet 2004; 363: 2049–51PubMedCrossRefGoogle Scholar
  26. 26.
    ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002; 288: 2981–97CrossRefGoogle Scholar
  27. 27.
    Dahlof B, Devereux RB, Kjeldsen SE, et al. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002; 359: 995–1003PubMedCrossRefGoogle Scholar
  28. 28.
    Pepine CJ, Handberg EM, Cooper-DeHoff RM, et al. A calcium antagonist vs a non-calcium antagonist hypertension treatment strategy for patients with coronary artery disease. The International Verapamil-Trandolapril Study (INVEST): a randomized controlled trial. JAMA 2003; 290: 2805–16PubMedCrossRefGoogle Scholar
  29. 29.
    Singer GM, Izhar M, Black HR. Goal-oriented hypertension management: translating clinical trials to practice. Hypertension 2002; 40: 464–9PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2006

Authors and Affiliations

  1. 1.Medizinische Poliklinik, UniversitaetsspitalLausanne UniversityBaselSwitzerland
  2. 2.Fukuoka UniversityFukuokaJapan

Personalised recommendations