Antihypertensive Efficacy of Amlodipine and Losartan after Two ‘Missed’ Doses in Patients with Mild to Moderate Essential Hypertension

Abstract

We compared the effects of amlodipine (5-10 mg, n=94) and losartan (50-100 mg, n=94) on the lowering of blood pressure (BP) at steady state and after two missed doses, as well as on tolerability. This was a randomized, double-blind study of 12 weeks of active treatment followed by 2 days of placebo treatment. Twenty-four-hour ambulatory blood pressure monitoring and office BP measurements were performed at baseline, week 12 and after the 2-day drug holiday. After 12 weeks, amlodipine was significantly more effective than losartan in reducing both 24-h systolic blood pressure (SBP) (-18.0 versus -10.8 mmHg) and diastolic blood pressure (DBP) (-10.6 versus -8.0 mmHg). While mean SBP and DBP for both treatments increased comparably during the drug holiday, BP values remained significantly lower than baseline for both treatments. The superior BP-lowering effect of amlodipine compared with losartan was maintained during the drug holiday.

Sustained Blood Pressure–Lowering Effect of Aliskiren Compared With Telmisartan After a Single Missed Dose

“…Depending on their pharmacokinetic profiles, the efficacy of most antihypertensive agents declines over a 24‐hour dosing interval. Drugs with long intrinsic half‐lives and consequently slower offset of action such as the thiazide‐type diuretic chlorthalidone ( t 1/2 ∼50 hours), 6 the dihydropyridine calcium channel blocker (CCB) amlodipine ( t 1/2 35–50 hours), 7 the direct renin inhibitor aliskiren ( t 1/2 ∼40 hours), 8,9 and the angiotensin receptor blocker (ARB) telmisartan ( t 1/2 ∼24 hours), 10 could be of greater therapeutic value, especially in the event of missed doses 11–13 …”