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The effect of antihypertensive agents in people at high risk of cardiovascular disease and diabetes: a view through smoke and mirrors

Journal of Human Hypertension volume 25, pages 343–345 (2011)Cite this article

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The paper by Francisco Javier Martinez-Martin et al.1 reports a study of the effect of treatment with olmesartan/amlodipine and olmesartan/hydrochlorothiazide on inflammatory and metabolic markers in people with hypertension and the metabolic syndrome. Blood pressure, albuminuria and C-reactive protein were reduced similarly in both groups. However, only olmesartan/amlodipine reduced insulin resistance, other inflammatory markers and increased plasma adiponectin. The risk of new-onset diabetes was also significantly less with this combination. Thus, there were clear differences between the two olmesartan-based combinations. It is suggested that the combination with amlodipine may have advantages in such high-risk individuals.

The benefit of blood pressure lowering was established by virtue of high-quality, robust data from large trials with hard end points. The benefit is proportional to baseline risk and, therefore, high-risk people achieve high absolute gain. Driven largely by commercial interests, newer antihypertensive agents were pitted against conventional drugs in several hugely expensive large outcome trials. No convincing net advantage emerged. It appears that what you do is much more important than the way by which you do it.

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  1. Institute of Cardiovascular and Medical Sciences, University of Glasgow, Gardiner Institute, Glasgow, UK

    G T McInnes

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  1. G T McInnes
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Correspondence to G T McInnes.

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McInnes, G. The effect of antihypertensive agents in people at high risk of cardiovascular disease and diabetes: a view through smoke and mirrors. J Hum Hypertens 25, 343–345 (2011). https://doi.org/10.1038/jhh.2011.12

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