Olmesartan/amlodipine vs olmesartan/hydrochlorothiazide in hypertensive patients with metabolic syndrome: the OLAS study.

We studied the effects of treatment with olmesartan/amlodipine and olmesartan/hydrochlorothiazide on inflammatory and metabolic parameters (including new-onset diabetes as a secondary endpoint) in non-diabetic hypertensive patients with metabolic syndrome (MetS). A total of 120 patients with MetS and stage I and II hypertension were randomized to olmesartan 20 mg/amlodipine 5 mg or olmesartan 20 mg/hydrochlorothiazide 12.5 mg. If target systolic blood pressure (<140 mm Hg) was not reached, doses were doubled after 13 weeks; doxazosin 4 mg was added after 26 weeks, and doubled after 39 weeks; follow-up ended at 78 weeks. At each visit, blood pressure (BP), fasting plasma glucose, insulin, adiponectin, tumour necrosis factor-α, C-reactive protein (CRP), intercellular adhesion molecule-1, vascular cell adhesion molecule-1, interleukins-1ß, -6 and -8, and albuminuria were measured; BP was similarly reduced in both groups; 80% of patients reached target BP. Reductions in albuminuria were also similar (50%). Only olmesartan/amlodipine reduced the insulin resistance index (24%, P<0.01), increased plasma adiponectin (16%, P<0.05) and significantly reduced all of the inflammation markers studied, except CRP, which showed a similar reduction in each group. The risk of new-onset diabetes was significantly lower with olmesartan/amlodipine (P=0.02). Both olmesartan-based combinations were effective, but the amlodipine combination resulted in metabolic and anti-inflammatory effects that may have advantages over the hydrochlorothiazide combination.

Terapia combinada / Combination therapy

Está ampliamente demostrado que el control glucémico previene la aparición de complicaciones microvasculares. En la actualidad, contamos con varios tipos de antidiabéticos orales (ADO) e insulinas para lograr este objetivo. Dada la evolución natural de la diabetes, lo habitual es quesea necesaria la asociación de varios fármacos para lograr los objetivos deseados en su control. Además, se ha demostrado que la asociación de fármacos que actúen por diferentes mecanismos da lugar a una mejoría en el control metabólico. A este respecto, la guía EASD/ADA recomienda, tras el diagnóstico de diabetes mellitus tipo 2, comenzar el tratamiento con cambios en el estilo de vida y la administración de metformina. Si esto no logra un adecuado control glucémico, recomienda añadir un segundo ADO o insulina en un plazo de 2-3 meses. Y, en un tercer paso, si con esto tampoco se consiguen los objetivos deseados, se podría asociar insulina o intensificar el tratamiento con ésta. En el caso de una hemoglobina glucosilada < 8%se puede plantear la asociación de 3 ADO (AU)

Many studies have shown that glycemiccontrol prevents microvascular complications in diabetic patients. Currently, there are several kinds of hypoglycemic agents and forms of insulin to achieve this goal. Given the progressive nature of type 2diabetes, a combination of drugs is usually required. In addition, the association of drugs that act through different mechanisms improves glycemic control. The European Association for the Study of Diabetes/American Diabetes Association guidelines recommend that initial treatment consist of lifestyle modifications and metformin therapy. If the target objective is not achieved, a second hypoglycemic agent or insulin should be added within 2 or3 months. If these measures are still insufficient, insulin should be added or treatment intensified. If HbA1c levels are below 8%, 3 oral hypoglycemic agents can be combined (AU)