Exploring the Effectiveness and Safety of Azilsartan-Medoxomil/Chlorthalidone Versus Olmesartan-Medoxomil/Hydrochlorothiazide in Hypertensive Patients: A Meta-Analysis

Lakshya Kumar; Sundal Khuwaja; Aanand Kumar; Unaib Ahmed Memon; Munesh Kumar; Arpana Ashok; Manisha Lohana; Ahmed Qudoos; Maham Kashif; Mahima Khatri; Satesh Kumar; Fnu Sapna; Arjan Dass; Giustino Varrassi

doi:10.7759/cureus.41198

Exploring the Effectiveness and Safety of Azilsartan-Medoxomil/Chlorthalidone Versus Olmesartan-Medoxomil/Hydrochlorothiazide in Hypertensive Patients: A Meta-Analysis

Cureus. 2023 Jun 30;15(6):e41198. doi: 10.7759/cureus.41198. eCollection 2023 Jun.

Authors

Affiliations

¹ General Medicine, Pandit Dindayal Upadhyay (PDU) Medical College, Rajkot, IND.
² Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK.
³ Internal Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK.
⁴ Department of Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK.
⁵ Medicine, Khawaja Muhammad Safdar Medical College, Sialkot, PAK.
⁶ Medicine and Surgery, Dow University of Health Sciences, Karachi, PAK.
⁷ Medicine and Surgery, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, PAK.
⁸ Internal Medicine, Detroit Medical Center, Detroit, USA.
⁹ Internal Medicine, Willis-Knighton Health System, Shreveport, USA.
¹⁰ Pain Medicine, Paolo Procacci Foundation, Rome, ITA.

Abstract

This study aims to assess the effectiveness and safety of azilsartan-medoxomil/chlorthalidone (AZI-M/CT) compared to olmesartan-medoxomil/hydrochlorothiazide (OLM/HCTZ) in patients with hypertension. Systematic searches were conducted on PubMed, Google Scholar, and ClinicalTrials.gov, starting from their establishment until March 15, 2023. The purpose of these searches was to locate original reports that compare the effectiveness of AZI-M/CT and OLM/HCTZ in treating hypertension. Data on various characteristics at the beginning and end of the studies were gathered. The analyses were carried out using Review Manager 5.4.1 (The Nordic Cochrane Center, The Cochrane Collaboration, 2014, Odense, Denmark) and STATA 16.0 software (Stata Corp. LP, College Station, TX, USA). Risk ratios (RRs) and weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated as part of the study. A total of 3,146 individuals from four separate investigations were included in the study, with 1,931 individuals receiving AZI-M/CT and 1,215 individuals receiving OLM/HCTZ. The combined analysis revealed that the average diastolic blood pressure (DBP) was significantly lower in the AZI-M/CT group compared to the OLM/HCTZ group (WMD -2.64 [-2.78, -2.51]; P = 0.00001; I² = 1%). However, there were no significant differences in mean systolic blood pressure (SBP; WMD -2.95 [-6.64, 0.73]; P = 0). Furthermore, the AZI-M/CT group had a notably higher incidence of major adverse events (RR 1.58 [1.20, 2.08]; P = 0.001; I² = 11%) and any treatment-emergent adverse events (RR 1.11 [1.03, 1.20]; P = 0.007; I² = 51%). However, there was no significant difference in the mortality risk between the two groups (RR 0.74 [0.14, 3.91]; P = 0.72; I² = 0%). Based on the results of our meta-analysis, AZI-M/CT is more effective than OLM/HCTZ at reducing blood pressure in elderly hypertensive patients. However, because of the small sample size, favorable results must be carefully reevaluated, and more studies are needed.

Keywords: azi-m/ct; azilsartan-medoxomil; chlorthalidone; meta-analysis; olm/hctz; olmesartan; systematic review.

Publication types

Review