Expert Perspectives on the Clinical Use of Olmesartan + Calcium Channel Blockers + Diuretics Combination Therapy in the Management of Hypertension in Indian Settings

Manjula S *

Department of Medical Services, Micro Labs Limited, Bangalore, Karnataka, India.

Krishna Kumar M

Department of Medical Services, Micro Labs Limited, Bangalore, Karnataka, India.

*Author to whom correspondence should be addressed.


Abstract

Background: Although there are several studies available regarding the safety and effectiveness of olmesartan + calcium channel blockers (CCBs) + diuretics, there were dearth of studies among experts regarding the clinical use and prescription practices of olmesartan + calcium channel blockers (CCBs) + diuretics in Indian settings.

Methods: This cross-sectional study utilized a 23-item, multiple-response questionnaire to gather expert opinions from specialists with expertise in BP and hypertension-related management. The survey comprised questions regarding guideline compliance, prevailing prescription practices, and experiences associated with the use of mono, dual, and triple combination treatments for managing uncontrolled BP and hypertension-related comorbidities.

Results: Out of the 566 surveyed clinicians, around 50% adhered to the American College of Cardiology/American Heart Association (ACC/AHA) guidelines. Almost 43% of the clinicians reported that 10-20% of patients require triple-drug antihypertensive combination therapy. Around 34% of the experts indicated that 21-30% of patients achieve a BP below 130/80 mm Hg with triple antihypertensive combination therapy. Nearly 46% reported that 21-30% of their patients exhibit comorbid dyslipidemia. Approximately 53% of the clinicians noted increased prevalence of proteinuria in patients aged 46-60 years, and about 76% stated that angiotensin receptor blockers (ARBs) are most frequently used as first-line antihypertensive drugs. Nearly 90% of the respondents suggested that olmesartan monotherapy provided superior BP reduction. Around 58% of the experts reported that in individuals with co-morbid diabetes, the most commonly prescribed combination was olmesartan + CCB.

Conclusion: The survey highlighted clinician’s preference for the triple-drug combination therapy of olmesartan, CCBs, and diuretics, emphasizing its benefits in improving BP regulation and reducing hypertension-related complications. It also underscored the superior effectiveness of this combination over alternatives, noting advantages such as vasodilation and reductions in glucose and lipid levels.

Keywords: Hypertension, dyslipidemia, proteinuria, Olmesartan, calcium channel blockers, diuretics


How to Cite

S, Manjula, and Krishna Kumar M. 2024. “Expert Perspectives on the Clinical Use of Olmesartan + Calcium Channel Blockers + Diuretics Combination Therapy in the Management of Hypertension in Indian Settings”. Asian Journal of Research in Cardiovascular Diseases 6 (1):42-50. https://journalijrrc.com/index.php/AJRCD/article/view/101.

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References

Hypertension. [Accessed On:2024 May 30]. Available:https://www.who.int/health-topics/hypertension

Alsaadon H, Afroz A, Karim A, Habib SH, Alramadan MJ, Billah B. Hypertension and its related factors among patients with type 2 diabetes mellitus – A multi-hospital study in Bangladesh. BMC Public Health. 2022;22(1):198.

Joshi SR, Anjana RM, Deepa M, Pradeepa R, Bhansali A, Dhandania VK. Prevalence of dyslipidemia in Urban and Rural India: The ICMR–INDIAB Study. PLoS One. 2014;9(5): e96808.

Lee H, Park MS, Kang MK, Song TJ. Association between Proteinuria Status and Risk of Hypertension: A nationwide population-based cohort study. J Pers Med. 2023;13(9):1414.

Dalal JJ, Kerkar P, Guha S, Dasbiswas A, Sawhney JPS, Natarajan S. Therapeutic adherence in hypertension: Current evidence and expert opinion from India. Indian Heart Journal. 2021;73(6):667–73.

Gupta R, Gaur K, S Ram CV. Emerging trends in hypertension epidemiology in India. J Hum Hypertens. 2019;33(8):575-587.

Dawuda, Ali Sabior, Amidu Abdul-Aziz. 2023. To determine the pathogenesis and preventive strategies of hypertension-induced kidney failure among hypertensive patients in the Tamale Teaching Hospital, Ghana. Journal of Advances in Medicine and Medical Research 2023;35(22):62-75. Available:https://doi.org/10.9734/jammr/2023/v35i225247

Paraskar V, Sawarkar P, Sawarkar G. Management of hypertension through shodhana & shamana chikitsa: A systematic review, Journal of Pharmaceutical Research International. 2021;33(60B):822–835. DOI: 10.9734/jpri/2021/v33i60B34685

Parati G, Lombardi C, Pengo M, Bilo G, Ochoa JE. Current challenges for hypertension management: From better hypertension diagnosis to improved patients' adherence and blood pressure control. International Journal of Cardiology. 2021;331:262-9.

Stergiou GS, Kollias A, Zeniodi M, Karpettas N, Ntineri A. Home blood pressure monitoring: Primary role in hypertension management. Current hypertension reports. 2014;16(8):462.

Whelton PK, Carey RM, Mancia G, Kreutz R, Bundy JD, Williams B. Harmonization of the American College of Cardiology/American heart association and European Society of Cardiology/European Society of Hypertension Blood Pressure/ Hypertension Guidelines: Comparisons, Reflections, and Recommendations. Circulation. 2022;146 (11):868-877.

Barreras A, Gurk-Turner C. Angiotensin II receptor blockers. Proc (Bayl Univ Med Cent). 2003;16(1):123–6.

Kerndt CC, Soos MP. Olmesartan. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024.

[Accessed On:2024 May 30]. Available:http://www.ncbi.nlm.nih.gov/books/NBK544367/

McKeever RG, Patel P, Hamilton RJ. Calcium Channel Blockers. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024.

[Accessed On: 2024 May 30]. Available:http://www.ncbi.nlm.nih.gov/books/NBK482473/

Chakraverty R, Samanta K, Mandal P, Karmakar S. Chapter 16 - Mechanism of action of diuretic and anti-diuretic drugs. In: Kazmi I, Karmakar S, Shaharyar MdA, Afzal M, Al-Abbasi FA, editors. How synthetic drugs work academic press; 2023;369–90.

Zaman MA, Awais N, Satnarine T, Ahmed A, Haq A, Patel D. Comparing triple combination drug therapy and traditional monotherapy for better survival in patients with high-risk hypertension: A Systematic Review. Cureus. 2023;15(7):e41398.

Volpe M, Gallo G, Tocci G. New approach to blood pressure control: Triple combination pill. Trends in Cardiovascular Medicine. 2020;2:72-77.

Dyslipidemia: One of the main comorbidities associated with hypertension. Mindray.

[Accessed On: 2024 May 30] Available:https://www.mindray.com/en/media-center/blogs/dyslipidemia-one-of-the-main-comorbidities-associated-with-hypertension

Otsuka T, Takada H, Nishiyama Y, Kodani E, Saiki Y, Kato K. Dyslipidemia and the risk of developing hypertension in a working‐age male population. J Am Heart Assoc. 2016;5(3): e003053.

Chen R, Suchard MA, Krumholz HM, Schuemie MJ, Shea S, Duke J, Pratt N, Reich CG, Madigan D, You SC, Ryan PB, Hripcsak G. Comparative first-line effectiveness and safety of ACE (Angiotensin-Converting Enzyme) inhibitors and angiotensin receptor blockers: A multinational cohort study. Hypertension. 2021;78(3):591-603.

ARBs in hypertension. The British Journal of Cardiology

[Accessed On: 2024 May 30].

Available:https://bjcardio.co.uk/2010/05/arbs-in-hypertension/

Abbasi J. Choose ARBs Over ACE inhibitors for first-line hypertension treatment, large new analysis suggests. JAMA. 2021;326(13):1244-1245.

Nakayama S, Watada H, Mita T, Ikeda F, Shimizu T, Uchino H. Comparison of effects of olmesartan and telmisartan on blood pressure and metabolic parameters in Japanese Early-Stage Type-2 Diabetics with Hypertension. Hypertens Res. 2008; 31(1):7–13.

Bell AM, Nykamp D. Hypertension: Focus on Olmesartan Medoxomil. Clinical Medicine Therapeutics. 2009;1. DOI:10.4137/CMT.S2206

Redon J, Weber MA, Reimitz PE, Wang JG. Comparative effectiveness of an angiotensin receptor blocker, olmesartan medoxomil, in older hypertensive patients. J Clin Hypertens (Greenwich). 2018; 20(2):356-365.

Kim JH, Joo HJ, Chung SH, Yum Y, Kim YH, Kim EJ. Safety and cardiovascular effectiveness of olmesartan in combination therapy for advanced hypertension: an electronic health record-based cohort study. J Hypertens. 2023;41 (10):1578-1584.

Daikuhara H, Kikuchi F, Ishida T. The combination of OLmesartan and a CAlcium channel blocker (azelnidipine) or candesartan and a calcium channel blocker (amlodipine) in type 2 diabetic hypertensive patients: the OLCA study. Diab Vasc Dis Res. 2012;9(4):280–6.

Kalra S, Kalra B, Agrawal N. Combination therapy in hypertension: An update. Diabetology & Metabolic Syndrome. 2010; 2(1):44.

Greathouse M. Olmesartan medoxomil combined with hydrochlorothiazide for the treatment of hypertension. Vasc Health Risk Manag. 2006;2(4):401–9.