Efficacy of azilsartan medoxomil with chlorthalidone in hypertension

Abstract

Azilsartan medoxomil (AZL) is the most recently approved angiotensin receptor blocker (ARB) for treating patients with hypertension. A fixed-dose combination product with AZL and the thiazide-like diuretic chlorthalidone (CLD) is now available to treat individuals who require additional blood pressure lowering. For this review, a literature search was conducted using MEDLINE and the keywords and MeSH terms azilsartan, azilsartan medoxomil, chlorthalidone, thiazide, blood pressure and hypertension. References for retrieved articles were also scanned for relevant citations. No language restrictions were used. AZL is structurally related to candesartan and has been shown to provide more potent angiotensin receptor antagonism versus other ARBs. CLD is a thiazide-like diuretic with a longer half-life and greater blood pressure lowering efficacy than hydrochlorothiazide. The combination of AZL plus CLD has superior efficacy to other ARBs alone or in combination with hydrochlorothiazide based on extensive evaluation in clinical trials. This superior efficacy is not offset by a large imbalance in clinically important adverse events.

Keywords::

• angiotensin receptor blocker
• azilsartan medoxomil
• chlorthalidone
• combination
• hypertension

Financial & competing interests disclosure

WB White is presently a paid safety consultant to Takeda for chairing the adjudication committee of the febuxostat cardiovascular outcomes study and chairs the Steering Committee for the EXAMINE trial, an evaluation of the cardiovascular safety of alogliptin. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Initiation of drug therapy for treating hypertension often requires combination therapy in order to reach treatment goals.

• Azilsartan medoxomil (AZL) has been added to the thiazide-like diuretic chlorthalidone (CLD) in a fixed-dose combination.

• Clinical trials have shown the combination of AZL/CLD to reduce blood pressure to a greater amount compared with both their individual monotherapies and the combination of other angiotensin receptor blockers with hydrochlorothiazide.

• The adverse events related to AZL/CLD therapy are generally mild and transient in nature and similar to the individual components.

• This fixed-dose combination could help improve blood pressure control rates in practice and potentially translate into reductions in complications of hypertension.

Notes