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Omapatrilat Better Than Enalapril for Blood Pressure but Increases Angioedema Risk: Presented at ESC
By Ed Susman
Special to DG News
BERLIN, GERMANY -- September 5, 2002 -- High risk hypertensive patients -- particularly those with diabetes -- appear to do better on the investigative vasopeptidase inhibitor omapatrilat than on the angiotensin-converting enzyme inhibitor enalapril, researchers reported at the 24th annual congress of the European Society of Cardiology.
"Omapatrilat is consistently more efficacious than enalapril in reducing systolic blood pressure and achieving blood pressure control," said Michael A. Weber, MD, associate dean and professor of medicine at the State University of New York Health Science Center at Brooklyn.
In a "clinical trials update" report, Dr. Weber said analysis of the OCTAVE (Omapatrilat Cardiovascular Treatment Assessment Versus Enalapril) trial said that the drug does appear to cause more angioedema in the high-risk group of patients recruited for the trial.
About 1.18 percent of patients taking omapatrilat developed angioedema, compared with about 0.6 percent of patients taking enalapril in the study. The angioedema episodes generally occurred early in the trial and new cases were rare after six months.
Even in the patients who did suffer angioedema, Dr. Weber said the researchers observed no airway compromise or any need for mechanical intervention in those patients.
He said that omapatrilat was, in particular, advantageous to patients who were diabetic and patients whose blood pressure could not be controlled by ACE inhibition.
In the analysis of high-risk patients -- those with demonstrated atherosclerotic disease -- from the OCTAVE cohort, Dr. Weber and colleagues identified 2,371 patients who had previously had a myocardial infarction, angina pectoris, stroke or transient ischemic attack.
The patients received either omapatrilat or enalapril, and their physicians were urged to seek blood pressure control in the study. Patients following randomization stayed on their assigned medication for 8 weeks. If they had not met the blood pressure goal of 140/90 after 8 weeks, they were then continued for 16 weeks, but were allowed to receive adjunctive prescription medication.
Overall, patients talking omapatrilat reduced their blood pressure by about 3 to 4 mmHg. However, if a patient required more than two drugs to reach goal, the difference between omapatrilat and enalapril was nearly 6 mmHg. Dr. Weber said both differences were statistically significant.
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