Olmetec (olmesartan medoxomil), licensed in the UK for essential hypertension, is the first ARB to suggest a regression of atherosclerosis (plaque volume (PV)) , a major risk factor for cardiovascular disease (CVD), according to a study published in the inaugural issue of Therapeutic Advances in Cardiovascular Disease.
Regression of PV is a compelling clinical goal, with potential to prevent cardiovascular and cerebrovascular events.
In the Multicentre Olmesartan Atherosclerosis Regression Evaluation (MORE) study the primary endpoint, common carotid-intima media thickness (CC-IMT), a surrogate risk factor for CVD, decreased after two years of treatment with olmesartan.
A post hoc analysis in patients with larger plaques demonstrated a significant reduction in PV compared to atenolol, the active comparator, although change in PV for the whole study population only showed a trend towards significance for olmesartan (Olmetec, Daiichi Sankyo).
It was reported that this was a promising finding which provided a focus for further evaluation in future clinical studies.
In the MORE study, olmesartan did not significantly reduce PV compared with the beta-blocker atenolol in the overall population.
However a post hoc analysis of patients with above average plaques at baseline (those at greater risk of cardiovascular events) olmesartan showed a significant reduction in PV by -8.9%, compared with a 2.4% increase with atenolol.
In very large plaques the beneficial effect of olmesartan was even greater – PV declined by -12.8% and increased by 2.1% respectively in the olmesartan and atenolol groups. Both olmesartan and atenolol patients showed a similar reduction in blood pressure.
The observed decrease in plaque volume may thus occur independently of blood pressure lowering and offers a further potential benefit of olmesartan.
Dr Lina Izzat, associate specialist in cardiology at Prince Phillip Hospital, Llanelli, UK, commented: “The MORE study is a landmark because it is the first study to show an anti-atherosclerotic effect using an ARB.
“This suggests that in patients with hypertension, in addition to effective blood pressure lowering, olmesartan may potentially protect against cardiovascular and organ damage – benefits that should be considered seriously when prescribing an anti-hypertensive agent in patients who already have atherosclerotic disease.”