Ambulatory Blood Pressure Comparison of the Anti-hypertensive Efficacy of Fixed Combinations of Irbesartan/hydrochlorothiazide and Losartan/hydrochlorothiazide in Patients with Mild-to-moderate Hypertension

Abstract

This study examined whether the greater anti-hypertensive efficacy of irbesartan monotherapy over losartan monotherapy extends to the respective fixed-dose combinations with hydrochlorothiazide (HCTZ) in patients with mild-to-moderate hypertension. Patients were treated with either irbesartan 150 mg/HCTZ 12.5 mg or losartan 50 mg/HCTZ 12.5 mg over a 4-week period. Twenty-four hour daytime and night-time mean blood pressure (BP), BP load and duration of action were assessed using ambulatory BP monitoring. Both treatment regimens significantly reduced BP from baseline for all efficacy variables assessed. A significant difference was noted in adjusted mean changes from baseline in 24-h ambulatory diastolic BP with irbesartan/HCTZ versus losartan/HCTZ. Reduction in diastolic load was significantly greater with irbesartan/HCTZ than with losartan/HCTZ as was mean ambulatory systolic BP during the last 4 h of the dosing interval. Both regimens were well tolerated, with no significant differences in terms of adverse event profile observed. Irbesartan 150 mg/HCTZ 12.5 mg resulted in greater reductions in ambulatory BP than losartan 50 mg/HCTZ 12.5 mg.

Significance of initial blood pressure and comorbidity for the efficacy of a fixed combination of an angiotensin receptor blocker and hydrochlorothiazide in clinical practice

“…However the relative efficacy from the comparison of substances in monotherapy 7,8,11 is generally maintained for the corresponding combinations with HCTZ. 12,13 These studies showed a greater reduction in blood pressure from 150 mg irbesartan compared with 50 mg losartan 7,11,13 both with and without HCTZ. In a study with losartan 100 mg/HCTZ 25 mg, a reduction in blood pressure of 24.0/11.8 mmHg was achieved at an initial blood pressure of 160.8/94.4 mmHg.…”

Cost-effectiveness of irbesartan/hydrochlorothiazide in patients with hypertension: an economic evaluation for Sweden

“…In the study by Neutel and Smith, the difference in BP reduction between irbesartan and losartan was statistically significant only for DBP (P ¼ 0.01), perhaps due to the small sample size. However, using the study by Neutel and Smith represents a conservative approach, as the BP reductions with irbesartan in this study are slightly more favourable compared with the BP reductions with irbesartan in Bobrie et al, 28 which means that the relative efficacy of irbesartan compared with losartan may be underestimated if the data concerning losartan from Neutel and Smith 29 are compared indirectly with the data for irbesartan in Bobrie et al…”

“…Comparisons between irbesartan and losartan in mild-to-moderate hypertension are available in, for example, Kassler-Taub et al, 47 Neutel and Smith 29 and Oparil et al 48 For the base case analysis, the Neutel and Smith study was used here, even though the sample size is quite small (n ¼ 30). The study by Kassler and Taube did not include combination therapy and used only losartan 100 mg, and in Oparil et al the patients were uptitrated as needed from losartan 50-100 mg or from irbesartan 150-300 mg, and HCTZ was added if the goals were not reached.…”

“…The base case analysis was based on the BP reductions from Bobrie et al (COSIMA Study) and Neutel and Smith, 28,29 and was calculated for a 55-year-old male. The study by Bobrie et al included patients who were still uncontrolled after a lead-in phase of 5 weeks during which all patients were treated with HCTZ 12.5 mg. 28 The results of the intention-to-treat analysis of the home BP are shown in (candesartan).…”

Approaches to Selection of Antihypertension Drug Within Applied Lower Target Blood Pressure Levels

“…Результаты этого исследования свидетельствовали о статистически значимо более выраженном снижении систолического и диастоли-ческого АД при сочетанном приеме 150 мг ирбесар-тана и 12,5 мг ГХТЗ по сравнению с применением 80 мг валсартана и 12,5 мг ГХТЗ: снижение систоли-ческого АД при использовании такой терапии дости-гало 13 и 10,6 мм рт.ст., соответственно, (p=0,0094 для сравнения между группами), а диастолического АД -9,5 и 7,4 мм рт.ст., соответственно, (p=0,0007 для сравнения между группами). Сходные данные были получены и в ходе выполнения другого исследова-ния, включавшего больных со слабовыраженной или умеренной АГ [19]. Его результаты также свидетель-ствовали о более выраженном снижении диастоличе-ского АД, измеренного с помощью 24 ч АД монито-рирования, при сочетанном применении ирбесартана и ГХТЗ по сравнению с приемом лозартана в сочета-нии с ГХТЗ, которое достигало 10,5 и 6,1 мм рт.ст., соответственно, (p=0,001 для сравнения между груп-пами).…”