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To compare the relative efficacy and safety of olmesartan medoxomil (OM) with atenolol, captopril and losartan in phase III trials on mild to severely hypertensive patients.Multi-centre, randomized, double-blind, parallel group, with dose-titration studies lasting 12 or 24 weeks.Two studies respectively compared 10 mg OM once daily (o.d.) with: (1) 50 mg atenolol o.d. in moderate to severe hypertensives receiving 25 mg hydrochlorothiazide o.d. over 12 weeks; and (2) 50 mg losartan o.d. in mild to moderate hypertensives over 24 weeks, both with dose doubling at week 4 if required. Study 3 compared 5 mg OM o.d. plus placebo o.d.with 12.5 mg captopril twice daily in mild to moderate hypertensives over 12 weeks, with dose doubling at weeks 4 and 8 if required. The primary outcome measure for all studies was the change from baseline to week 12 in trough mean sitting diastolic blood pressure (DBP). Safety was monitored throughout all studies.(1) Atenolol and OM both reduced BP effectively in moderate to severe hypertensives. OM was significantly superior to: (2) losartan (95% confidence interval for baseline to week 12 change in DBP < 0, lower limit < -3.6 mmHg); and (3) captopril (95% confidence interval for baseline to week 12 change in DBP < 0, lower limit < -4.8 mmHg) in BP reduction for mild to moderate hypertensives. Treatment with OM was safe and well tolerated.At the doses tested, olmesartan medoxomil o.d. is as effective as atenolol, and more effective than both losartan and captopril in reducing blood pressure in the hypertensive population.