A randomized trial of the efficacy and safety of azilsartan medoxomil combined with chlorthalidone

We measured the effects of azilsartan medoxomil co-administered with chlorthalidone 25 mg in stage 2 hypertension. Azilsartan medoxomil 40 or 80 mg plus chlorthalidone were compared with placebo plus chlorthalidone once daily in a randomized, double-blind, 6-week trial. The primary endpoint was change from baseline in 24-hour mean systolic blood pressure by ambulatory blood pressure monitoring. Patients (N=551; mean age 59 years; 51.7% men) were randomly assigned to placebo plus chlorthalidone (n=184), azilsartan medoxomil 40 mg plus chlorthalidone (n=185), or azilsartan medoxomil 80 mg plus chlorthalidone (n=182). Baseline systolic blood pressures were similar among groups. After 6 weeks, least squares mean (standard error) reductions with azilsartan medoxomil 40 mg and 80 mg plus chlorthalidone were similar in magnitude (？31.7 (1.0) and ？31.3 (1.0) mmHg, respectively), but greater than chlorthalidone alone (？15.9 (1.0) mmHg). Hypotension and serum creatinine elevations were more frequent with azilsartan medoxomil plus chlorthalidone than chlorthalidone alone (reversed with drug discontinuation). Notably, plasma potassium reduction of 0.43 meq/L with chlorthalidone was attenuated to 0.13 and 0.05 meq/L by azilsartan medoxomil 40 mg and 80 mg, respectively. Azilsartan medoxomil 40 mg or 80 mg plus chlorthalidone 25 mg was significantly more efficacious than chlorthalidone alone in reducing blood pressure and was well tolerated. Clinicaltrial.gov, https://clinicaltrials.gov/ct2/show/NCT00591773, NCT0059177