What is the management plan for a patient with stage 2 hypertension on Cardizem (Diltiazem) 180mg daily and Olmesartan Medoxomil/Hydrochlorothiazide 40mg-12.5mg tablet daily?

From the Guidelines

The patient's current medication regimen of Cardizem ER 180mg QD and Olmesartan Medoxomil/Hydrochlorothiazide 40mg-12.5mg Tablet QD is appropriate for stage 2 hypertension, and treatment should be continued with regular blood pressure monitoring to ensure the target blood pressure is achieved, as recommended by the 2020 international society of hypertension global hypertension practice guidelines 1. The patient has stage 2 hypertension, which is defined as a blood pressure of ≥160/100mmHg, and the current treatment approach aligns with the guidelines that suggest starting drug treatment immediately for grade 2 hypertension 1.

Key Considerations

• The current regimen includes a calcium channel blocker (diltiazem), an angiotensin II receptor blocker (olmesartan), and a thiazide diuretic (hydrochlorothiazide), which is a beneficial multi-mechanism approach to target different physiological pathways involved in blood pressure regulation.
• Blood pressure should be monitored regularly to ensure this regimen is effective, with a target generally below 130/80 mmHg.
• If blood pressure remains uncontrolled, dosage adjustments or addition of a fourth agent might be necessary.
• Lifestyle modifications, including reduced sodium intake, regular physical activity, weight management, limited alcohol consumption, and smoking cessation, should be encouraged to complement pharmacological therapy.

Treatment Approach

• The 2020 international society of hypertension global hypertension practice guidelines recommend starting lifestyle interventions and drug treatment immediately for patients with grade 2 hypertension 1.
• The guidelines also suggest that high-risk patients, such as those with cardiovascular disease, chronic kidney disease, diabetes, organ damage, or aged 50-80 years, should start drug treatment immediately 1.
• The patient's current medication regimen and lifestyle modifications should be regularly assessed and adjusted as needed to ensure optimal blood pressure control and minimize the risk of cardiovascular complications.

From the FDA Drug Label

1. 1 Adult Hypertension Dosage must be individualized. The usual recommended starting dose of olmesartan medoxomil tablets is 20 mg once daily when used as monotherapy in patients who are not volume-contracted. For patients requiring further reduction in blood pressure after 2 weeks of therapy, the dose of olmesartan medoxomil tablets may be increased to 40 mg Doses above 40 mg do not appear to have greater effect. 14.1 Adult Hypertension A olmesartan medoxomil dose of 20 mg daily produces a trough sitting blood pressure (BP) reduction over placebo of about 10/6 mmHg and a dose of 40 mg daily produces a trough sitting BP reduction over placebo of about 12/7 mmHg. Olmesartan medoxomil doses greater than 40 mg had little additional effect

The patient is currently taking Olmesartan Medoxomil/Hydrochlorothiazide 40mg-12.5mg. The maximum recommended dose of Olmesartan Medoxomil is 40mg and the patient is already at this dose.

• The patient's current dose is within the recommended range.
• Increasing the dose above 40mg is unlikely to have a significant additional effect on blood pressure reduction.
• The patient should continue to be monitored and the treatment plan should be adjusted based on their response to the current medication regimen 2 2.

From the Research

Patient's Current Medication and Condition

The patient is currently taking Cardizem ER 180mg QD and Olmesartan Medoxomil/Hydrochlorothiazide 40mg-12.5mg Tablet QD for stage 2 hypertension.

Efficacy of Olmesartan Medoxomil/Hydrochlorothiazide Combination Therapy

• The combination of olmesartan medoxomil and hydrochlorothiazide has been shown to be effective in treating hypertension, with studies demonstrating increased antihypertensive efficacy compared to monotherapy with either agent alone 3, 4.
• The combination therapy has been found to be well-tolerated and effective in achieving recommended blood pressure targets, particularly in patients with moderate to severe hypertension 3, 5.
• High-dose olmesartan medoxomil (40 mg) plus hydrochlorothiazide has been shown to be an effective and safe treatment option for controlling blood pressure in patients with mild-to-severe hypertension 4.

Treatment Guidelines and Recommendations

• Guidelines recommend that many patients will require two or more antihypertensive agents from different classes to achieve blood pressure goals 3, 6.
• Combination therapy with an angiotensin II receptor blocker (ARB) and a diuretic, such as olmesartan medoxomil and hydrochlorothiazide, is a recommended treatment option for patients with hypertension 5, 6.
• The use of fixed-dose combinations, such as olmesartan medoxomil, amlodipine, and hydrochlorothiazide, has been shown to be effective and safe in treating hypertension, and can improve patient compliance and adherence to treatment 6, 7.

Patient-Specific Considerations

• The patient's current medication regimen includes a calcium channel blocker (Cardizem ER) and an ARB/diuretic combination (Olmesartan Medoxomil/Hydrochlorothiazide), which is consistent with recommended treatment guidelines 3, 6.
• The patient's stage 2 hypertension may require adjustments to their medication regimen to achieve optimal blood pressure control, and the use of combination therapy with multiple agents may be necessary 4, 7.