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The ‘pyrrhic victory’ of amlodipine over hydrochlorothiazide in the OLAS Study

Journal of Human Hypertension volume 25, pages 401–402 (2011)Cite this article

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We read with interest the well-written article by Martinez-Martin et al.1 entitled ‘olmesartan/amlodipine versus olmesartan/hydrochlorothiazide in hypertensive patients with metabolic syndrome: the OLAS Study’. The authors by using a parallel group, prospective open-label, blinded end-point design, have elegantly shown that both olmesartan combinations were well tolerated, effective in reducing blood pressure and additionally demonstrated benefit for different cardiorenal risk markers. Moreover, amlodipine (5–10 mg per day) confirmed its reputation as a metabolically neutral drug with beneficial effects on the inflammatory milieu as compared with hydrochlorothiazide (12.5–25 mg per day).

However, there are several points not addressed by the presentation of the OLAS Study, thus generating some concerns. First, no lifestyle interventions were implemented in that group of high-cardiovascular-risk patients. Interestingly, both body mass index and waist circumference were almost similar between baseline and after 78 weeks of follow-up. The latter phenomenon explains per se that the main component of metabolic syndrome, namely, increased central adiposity, remained unchanged even in the context of the ameliorated metabolic disorder; inflammatory; and hemodynamic pattern resulted from the ongoing amlodipine-oriented therapy. Second, it is known that patients with metabolic syndrome are characterized by impaired sodium handling and nocturnal hypertension, two mechanisms explaining at least partly the pathophysiological pathways of the hypertensive status.2 No measure for these situations is delivered by the design of the OLAS Study (that is, 24-h sodium excretion and blood pressure measurement), thus creating some queries for both the salt-sensitivity status and the overall hemodynamic load of the studied population. Third, it is ignored that metabolic-syndrome patients frequently experience sleep apnoea syndrome, which constitutes an outstanding confounder for the investigated outcomes.3, 4 Finally, with respect to the timing of drug administration, it is not reported whether office blood pressure measurements were performed before the delivery of the morning pill or whether that issue was completely ignored in the investigational pathway. In the same lines, in our view, morning blood pressure measurements were performed in a very large interval (from 0830 to 1130 hours) of time.

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References

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Authors and Affiliations

  1. Department of Cardiology, Elena Venizelou Hospital, Athens, Greece

    C Thomopoulos & T Makris

  2. First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece

    C Tsioufis & C Stefanadis

Authors
  1. C Thomopoulos
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  2. C Tsioufis
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  3. T Makris
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  4. C Stefanadis
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Correspondence to C Thomopoulos.

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Thomopoulos, C., Tsioufis, C., Makris, T. et al. The ‘pyrrhic victory’ of amlodipine over hydrochlorothiazide in the OLAS Study. J Hum Hypertens 25, 401–402 (2011). https://doi.org/10.1038/jhh.2011.14

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