Comparison of once daily versus twice daily olmesartan in patients with chronic kidney disease

Background: The effects of olmesartan (OLM) on blood pressure and kidney function in Japanese patients with chronic kidney disease (CKD) were compared between 20mg twice daily (BID) and 40mg once daily (QD) treatments. Methods: The subjects were Japanese CKD patients with concurrent hypertension who had been treated with OLM 20mg BID for at least 3months on an outpatient basis (n=39). After a change in the treatment regimen to 40mg OLM QD (after breakfast), blood pressure (BP) (n=39), morning home BP (n=13), estimated glomerular filtration rate (n=39), and urinary albumin-to-creatinine ratio (n=17) were monitored for 2months. Results: No significant change in office (mean +/- standard deviation [SD] [mmHg], 143.9 +/- 18.8/ 75.7 +/- 12.0 to 141.6 +/- 16.1/ 74.7 +/- 11.7, not significant [ns]) or early morning home (mean +/- SD [mmHg], 133.8 +/- 15.9/ 71.2 +/- 11.5 to 133.8 +/- 13.9/ 74.5 +/- 10.5, ns) BP was observed 2months after the change in dose. The estimated glomerular filtration rate increased significantly (mean +/- SD, 49.0 +/- 28.0 to 51.8 +/- 27.0, P<0.05), whereas urinary albumin-to-creatinine ratio did not change significantly (mean +/- SD, 0.551 +/- 0.445 to 0.364 +/- 0.5194, ns). Conclusion: High-dose OLM administered BID and QD had similar effects on outpatient and early morning home BP in CKD patients, suggesting that the BID regimen can be safely changed to a QD regimen. For CKD patients with hypertension requiring continuous long-term treatment, the possibility that the QD regimen might bring a greater therapeutic effect was suggested. However, recognizing the best blood pressure control level for a CKD patient is still a matter of debate, and should ideally be personalized.