This document summarizes the OSCAR study which compared high-dose olmesartan to standard-dose olmesartan plus a calcium channel blocker in 1164 elderly Japanese patients with uncontrolled hypertension. The study found that blood pressure was better controlled with the combination therapy, with a 2.4 mmHg lower systolic and 1.7 mmHg lower diastolic blood pressure. There was no significant difference in the primary outcome of cardiovascular events and death between the two groups. However, subgroup analysis found that patients with preexisting cardiovascular disease benefited more from the combination therapy, with significantly fewer cardiovascular events and deaths.

1. OSCAR (Olmesartan and Calcium
Antagonists Randomized Study)

2. OSCAR (Olmesartan and Calcium Antagonists
Randomized Study)
H Ogawa (Kumamotom University, Japan)
American College of Cardiology 2011 Scientific Sessions
• Population and treatment:
1164 high-risk elderly Japanese patients with uncontrolled hypertension
(SBP >140 mm Hg, DBP >90 mm Hg) on standard-dose (20-mg/d)
monotherapy with the ARB olmesartan and ≥1 of the following risk factors:
Cerebrovascular disease, cardiac disease, vascular disease, or type 2
diabetes mellitus
Randomized to high-dose olmesartan (40 mg per day) or standard dose
calcium-channel blocker (CCB) (amlodipine or azelnidipine) with 20-mg/day
olmesartan
Adding other antihypertensive drugs (except ARBs, ACE inhibitors, and
CCBs) was allowed if BP remained uncontrolled
• Primary outcome:
A composite of CV events* and all-cause death
*Including cerebrovascular disease, CAD, HF, other atherosclerotic disease, diabetic complications, and
the deterioration of renal function

3. OSCAR: Results
• BP was adequately controlled in both groups but significantly more important
reductions were seen with combination therapy
SBP 2.4 mm Hg lower (p=0.0315)
DBP 1.7 mm Hg lower (p=0.0240)
• Primary end point: No significant difference seen between the two treatment arms
48 events in the combination group compared with 58 in the high-dose-ARB
group (HR1.21; p=0.1717)
• Subgroup analysis
Patients with preexisting CV disease appeared to benefit more from
combination therapy: significantly more CV events and death with high-dose-
ARB (HR=1.63; p=0.02610)

4. OSCAR: Commentary*
"The OSCAR study provides the first evidence showing that a standard dose of
ARB plus CCB combination is superior to high-dose ARB in reducing adverse
events in elderly hypertensive patients with cardiovascular disease."
- Dr Hisao Ogawa
"Extremely relevant with our aging population, where in the US alone 11 000 baby
boomers are turning 65 every day."
- Dr Sara J Sirna
"We definitely need a new study to examine whether ARB [dose] doubling or ARB
plus CCB is good for diabetic hypertensive patients."
- Dr Toyoaki Murohara
*All comments from OSCAR: Antihypertensive choice in elderly should be guided by underlying
disease (http://www.theheart.org/article/1207871.do)

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