Changeover Trial of Azilsartan and Olmesartan Comparing Effects on the Renin-Angiotensin-Aldosterone System in Patients With Essential Hypertension After Cardiac Surgery (CHAOS Study)

Ann Thorac Cardiovasc Surg. 2016 Jun 20;22(3):161-7. doi: 10.5761/atcs.oa.16-00054. Epub 2016 Apr 18.

Abstract

Background: Angiotensin II receptor blockers (ARBs) have been widely used to treat hypertension and large-scale clinical studies have shown various benefits. In this study, we compared olmesartan with azilsartan, the newest ARB.

Methods: The subjects were outpatients who were clinically stable after cardiac surgery. Sixty patients were randomized to receive either azilsartan or olmesartan for 1 year and were switched to the other drug for the following 1 year. The primary endpoints were the levels of plasma renin activity, angiotensin II, and aldosterone.

Results: Home blood pressure exceeded 140/90 mmHg and additional antihypertensive medication was administered to 12 patients (20 episodes) in the azilsartan group versus 4 patients (4 episodes) in the olmesartan group, with the number being significantly higher in the azilsartan group. After 1 year of treatment, both angiotensin II and aldosterone levels were significantly lower in the olmesartan group than the azilsartan group. Left ventricular mass index was also significantly lower in the olmesartan group than the azilsartan group.

Conclusion: This study showed that olmesartan reduces angiotensin II and aldosterone levels more effectively than azilsartan. Accordingly, it may be effective in patients with increased renin-angiotensin-aldosterone system activity after cardiac surgery or patients with severe cardiac hypertrophy.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Aldosterone / blood
  • Angiotensin II / blood
  • Angiotensin II Type 1 Receptor Blockers / therapeutic use*
  • Antihypertensive Agents / therapeutic use*
  • Benzimidazoles / adverse effects
  • Benzimidazoles / therapeutic use*
  • Biomarkers / blood
  • Blood Pressure / drug effects*
  • Cardiac Surgical Procedures* / adverse effects
  • Drug Substitution*
  • Essential Hypertension
  • Female
  • Humans
  • Hypertension / blood
  • Hypertension / diagnosis
  • Hypertension / drug therapy*
  • Hypertension / physiopathology
  • Hypertrophy, Left Ventricular / drug therapy
  • Hypertrophy, Left Ventricular / physiopathology
  • Imidazoles / adverse effects
  • Imidazoles / therapeutic use*
  • Japan
  • Male
  • Middle Aged
  • Oxadiazoles / adverse effects
  • Oxadiazoles / therapeutic use*
  • Prospective Studies
  • Renin / blood
  • Renin-Angiotensin System / drug effects*
  • Tetrazoles / adverse effects
  • Tetrazoles / therapeutic use*
  • Time Factors
  • Treatment Outcome
  • Ventricular Remodeling / drug effects

Substances

  • Angiotensin II Type 1 Receptor Blockers
  • Antihypertensive Agents
  • Benzimidazoles
  • Biomarkers
  • Imidazoles
  • Oxadiazoles
  • Tetrazoles
  • Angiotensin II
  • Aldosterone
  • olmesartan
  • Renin
  • azilsartan