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Issue 8, 2009
HOT TOPICS IN HYPERTENSION
New therapeutic progress in cardiorenal protection of the hypertensive patient with a focus on olmesartan
| Publ. date: | 2009 |
| ISBN: | 978-88-6450-017-1 |
| ISSN: | 1973-963X |
| E-ISSN: | 2036-0908 |
| DOI: | 10.4147/HTH-090800 |
Abstract
There exists a bidirectional relationship between renal disease and cardiovascular disease (CVD). Thus, renal disease facilitates the development of CVD, and CVD promotes the establishment and progression of renal dysfunction. Hypertension is the most important risk factor for the development of both. To prevent the establishment and development of these two entities, it is necessary to attain blood pressure (BP) control and reduce urinary albumin excretion as much as possible. In this context, inhibition of the renin angiotensin system appears to be the best alternative.
On the other hand, the majority of hypertensive patients, particularly those at higher risk, will need at least two drugs to achieve BP goals. The fixed combination of olmesartan medoxomil/hydrochlorothiazide (HCTZ) is a very effective and well-tolerated rational combination. Some studies suggest that this combination is more effective and faster acting than other drug combinations. Moreover, available data suggest that olmesartan provides beneficial effects beyond BP reduction.
In this article the current evidence about olmesartan/HCTZ combination therapy is reviewed.
Table of contents
Foreword
The disease burden associated with arterial hypertension is still very high today. Despite the evident progress in the diagnosis and treatment of hypertension and its cardiovascular and renal consequences that has been achieved over the last 30 years, the rate of growth of ischemic heart disease, stroke, congestive heart failure and chronic kidney failure continues to escalate worldwide. Several potential factors contribute to this worrisome situation, but the principal cause is most likely cardiorenal damage secondary to poor control of blood pressure. Thus, any progress in the therapeutic management of hypertension deserves our utmost attention.
In this light, this review by Barrios and co-workers is timely and appropriate. Starting from the core of the problem–the unmet need of control of hypertension and its increasing socioeconomic burden–the authors analyze the impact of cardiorenal involvement in hypertensive patients and focus on the importance of the pathophysiologic role of the renin-angiotensin system. They present strong evidence to support the case that blockade of the renin-angiotensin system should be considered a cornerstone of antihypertensive therapy. Not only does this approach achieve desirable blood pressure control, but it is now well documented that drugs that block the renin-angiotensin system have significant cardiorenal protective properties. Accordingly, the authors also discuss the most recent major clinical trials based on the use of angiotensin receptor blockers (ARBs).
Within this class of drugs the authors focus on olmesartan medoxomil, a molecule endowed with specific pharmacokinetic properties as well as with remarkable blood-pressure-lowering action and a good tolerability profile. They review in detail the clinical development of this ARB, revisiting several important studies, especially ones based on antihypertensive therapy, and they also report interesting evidence of cardiac, vascular, and renal protection by olmesartan in hypertension and diabetes.
The review is up to date and well written, and I am confident that physicians everywhere will find this work of great help in obtaining important clinical information on the general problem of cardiorenal protection in hypertension and on the specific clinical profile of olmesartan medoxomil.
ARTICLES
New therapeutic progress in cardiorenal protection of the hypertensive patient with a focus on olmesartan
Vivencio Barrios, Fernando de Alvaro, Rocio Echarri, Carlos Escobar
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Editor-in-chief
Massimo Volpe - MD, FAHA, FESC
Hypertension is currently the most frequent clinical cardiovascular disease, affecting more than 800 million people throughout the world. Reliable sources predict that more than 1.2 billion persons wi...
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