Hydrochlorothiazide as add-on to Olmesartan/Amlodipine in Hypertension

Daiichi Sankyo

Status and phase: Completed; Phase 3

Conditions: Essential Hypertension

Treatments: Drug: OLM 40mg-AML 10mg-Hydrochlorothiazide 12.5mg; Drug: Olmesartan medoxomil 40 mg - Amlodipine 10 mg; Drug: Olmesartan 40mg-Amlodipine 10mg-Hydrochlorothiazide 25mg; Drug: Olmesartan 40mg-Amlodipine 10mg-Hydrochlorothiazide 12.5mg; Drug: OLM 40mg-AML 10mg-Hydrochlorothiazide 25mg

Study type: Interventional

Funder types: Industry

Identifiers

NCT00902538

CS8635-A-E303

Details and patient eligibility

About

Both Olmesartan (OLM)/Amlodipine (AML) combination and Hydrochlorothiazide (HCTZ) have proven to be efficacious and safe in lowering blood pressure, but may not always be sufficient. This study is to test efficacy and safety of the combination of OLM/AML and HCTZ in hypertensive patients whose blood pressure is not adequately controlled with OLM/AML alone. The following treatments will be included in the trial: OLM 40mg/AML 10mg; OLM 40mg/AML 10 mg/HCTZ 12.5 mg; OLM 40 mg/AML 10 mg/HCTZ 25 mg. The trial has four periods. The treatments that will be used are as follows:

Period 1 - OLM 40mg/AML 10mg; Period 2 - OLM 40mg/AML 10mg or OLM 40mg/AML 10 mg/HCTZ 12.5 mg or OLM 40 mg/AML 10 mg/HCTZ 25 mg; Period 3 - OLM 40mg/AML 10 mg/HCTZ 12.5 mg; Period 4 - Period 3 responders: OLM 40mg/AML 10 mg/HCTZ 12.5 mg; Period 4 - Period 3 non-responders: OLM 40mg/AML 10 mg/HCTZ 12.5 mg or OLM 40 mg/AML 10 mg/HCTZ 25 mg

Enrollment: 2,204 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Male or female aged 18 years or older.
• Mean trough seated systolic blood pressure (SeSBP) of ≥ 160/100 mmHg (SeSBP of ≥ 160 mmHg and seated diastolic blood pressure (SeDBP) ≥ 100 mmHg) at screening if not currently on antihypertensive medication (e.g. newly diagnosed subjects)

OR:

For subjects on monotherapy: mean trough SeSBP of ≥ 150/95 mmHg (SeSBP of ≥ 150 mmHg and SeDBP ≥ 95 mmHg) at screening

OR:

For subjects on any combination of antihypertensive medications that includes either hydrochlorothiazide or amlodipine or olmesartan for a duration of at least four weeks: mean trough SeSBP of ≥ 140/90 mmHg (SeSBP of ≥ 140 mmHg and SeDBP ≥ 90 mmHg) at screening

OR:

For subjects on any other combination of antihypertensive medications that includes neither hydrochlorothiazide, amlodipine nor olmesartan: mean trough SeSBP ≥ 160 mmHg, mean trough SeDBP ≥ 100mmHg, at the end of the taper-off period

• Subject freely signs the Informed Consent Form (ICF) after the nature of the study and the disclosure of his/her data has been explained.
• Female subjects of childbearing potential must be using adequate contraception (female of childbearing potential is defined as one who has not been postmenopausal for at least one year, or has not been surgically sterilised, or has not had a hysterectomy at least three months prior to the start of this study [Visit 1]). Females taking oral contraceptives should have been on therapy for at least three months. Adequate contraceptives include hormonal intra-uterine devices, hormonal contraceptives (oral, depot, patch or injectable), and double barrier methods such as condoms or diaphragms with spermicidal gel or foam. If a female becomes pregnant during the study, she has to be withdrawn immediately.

Exclusion criteria

• Female subjects of childbearing potential who are pregnant or lactating.

• Subjects with serious disorders which may limit the ability to evaluate the efficacy or safety of the investigational products, including cerebrovascular, cardiovascular, renal, respiratory, hepatic, gastrointestinal, endocrine or metabolic, haematological or oncological, neurological, and psychiatric diseases. The same applies for immunocompromised and/or neutropenic subjects.

• Subjects having a history of the following within the last six months: myocardial infarction (MI), unstable angina pectoris, percutaneous coronary intervention, heart failure, hypertensive encephalopathy, cerebrovascular accident (stroke), or transient ischaemic attack.

• Subjects with clinically significant abnormal laboratory values at Screening, including subjects with one or more of the following:

  • Aspartate aminotransferase (AST) > 3 times upper limit of normal (ULN)
  • Alanine aminotransferase (ALT) > 3 times ULN
  • Gamma-glutamyltransferase (GGT) > 3 times ULN
  • Potassium above ULN (unless high value is due to haemolytic blood sample)

• Subjects with secondary hypertension of any aetiology such as renal disease, phaeochromocytoma, or Cushing's syndrome.

• Subjects with contraindication to olmesartan, amlodipine, hydrochlorothiazide, or any of the excipients.

• Subjects with a mean SeSBP > 200 mmHg or mean SeDBP > 115 mmHg or bradycardia (heart rate < 50 beats/min at rest documented by mean radial pulse rate [PR] or electrocardiogram [ECG]) at Screening (Visit 1) or immediately before taking Period I study medication (Visit 2).

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Triple Blind

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2,204 participants in 6 patient groups

Olmesartan (OLM) 40mg-Amlodipine (AML) 10mg

Experimental group

Description:

The participants in this arm received these 2 drugs for the 8-week, single-blind, run-in Period 1. Participants could then randomized to this same combination for an additional 8 weeks in the double-blind, Period 2.

Treatment:

Drug: Olmesartan medoxomil 40 mg - Amlodipine 10 mg

Olmesartan 40mg-Amlodipine 10mg-Hydrochlorothiazide 12.5mg

Experimental group

Description:

Participants could start receiving this combination in randomized, double-blind, 8-week Period 2. This combination was continued into single-blind, 8-week Period 3 for all participants entering Period 3.

Treatment:

Drug: Olmesartan 40mg-Amlodipine 10mg-Hydrochlorothiazide 12.5mg

Olmesartan 40mg-Amlodipine 10mg-Hydrochlorothiazide 25mg

Experimental group

Description:

Participants could start receiving this combination in randomized, double-blind, 8- week Period 2.

Treatment:

Drug: Olmesartan 40mg-Amlodipine 10mg-Hydrochlorothiazide 25mg

OLM 40mg-AML 10mg-Hydrochlorothiazide 12.5mg (Responders)

Experimental group

Description:

Participants who meet their blood pressure goals in Period 3 and continued into the 8-week, double-blind Period 4 continued to receive this combination.

Treatment:

Drug: OLM 40mg-AML 10mg-Hydrochlorothiazide 12.5mg

Drug: OLM 40mg-AML 10mg-Hydrochlorothiazide 12.5mg

OLM 40mg-AML 10mg-Hydrochlorothiazide 12.5mg (Non-responders)

Experimental group

Description:

Participants finishing Period 3, but, who did not meet their blood pressure goals could receive this combination in the double-blind, randomized, Period 4

Treatment:

Drug: OLM 40mg-AML 10mg-Hydrochlorothiazide 12.5mg

Drug: OLM 40mg-AML 10mg-Hydrochlorothiazide 12.5mg

OLM 40mg-AML 10mg-Hydrochlorothiazide 25mg (Non-responders)

Experimental group

Description:

Participants finishing Period 3, but, who did not meet their blood pressure goals could receive this combination in the double-blind, randomized, Period 4

Treatment:

Drug: OLM 40mg-AML 10mg-Hydrochlorothiazide 25mg