In this paper, we present the results of a reanalysis of the data of two large randomized, double-blind, parallel group studies with a similar design, comparing the efficacy of an
angiotensin-receptor blocker (
olmesartan medoxomil) with that of an
angiotensin-converting enzyme inhibitor (
ramipril), by applying two different blood pressure targets recently recommended by
hypertension guidelines for all patients, irrespective of the presence of diabetes (<140/90 mmHg), and for elderly hypertensive patients (<150/90 mmHg). The efficacy of
olmesartan was not negatively affected by age, sex,
hypertension type, diabetes status or other concomitant clinical conditions, or cardiovascular risk factors. In most cases,
olmesartan provided better blood pressure control than
ramipril.
Olmesartan was significantly more effective than
ramipril in male patients, in younger patients (aged 65-69 years), in those with
metabolic syndrome,
obesity,
dyslipidemia, preserved renal function, diastolic ±
systolic hypertension, and, in general, in patients with a high or very high cardiovascular risk. Interestingly, patients previously untreated or treated with two or more
antihypertensive drugs showed a significantly larger response with
olmesartan than with
ramipril. Thus, our results confirm the good efficacy of
olmesartan in elderly hypertensives even when new blood pressure targets for
antihypertensive treatment are considered. Such results may be relevant for the clinical practice, providing some hint on the possible different response of elderly hypertensive patients to two different drugs acting on the renin-angiotensin system, when patients are targeted according to the blood pressure levels recommended by recent
hypertension guidelines.