Differential effects of strict blood pressure lowering by losartan/hydrochlorothiazide combination therapy and high-dose amlodipine monotherapy on microalbuminuria: the ALPHABET study

Fukutomi, Motoki; Hoshide, Satoshi; Eguchi, Kazuo; Watanabe, Tomonori; Shimada, Kazuyuki; Kario, Kazuomi

doi:10.1016/j.jash.2011.09.004

Cited by 12 publications

(8 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The meta-analysis of the FDC clearly shows that the compliance significantly increase by 21% compared with 2 separate pills, and the BP-lowering and the incidence of adverse reactions tend to improve [35]. In previous studies that investigate the effects of the FDC of an ARB and thiazide diuretics have shown reduction in the nocturnal BP [36], urinary albumin excretion [37], and plasma BNP [38], all consistent with our findings. However, the present study is, as far as we know, the first report that investigates the association of the BP-lowering effect of the FDC and the patients’ background, namely significant influence of obese.…”

Section: Discussionsupporting

confidence: 89%

The Fixed-Dose Combination of Losartan/Hydrochlorothiazide Elicits Potent Blood Pressure Lowering During Nighttime in Obese Hypertensive Patients

et al. 2013

View full text Add to dashboard Cite

BackgroundHypertension is one of the most powerful predictor of the future cardiovascular events, and antihypertensive therapy adopting multiple drug regimen is often needed to obtain the appropriate blood pressure (BP) control. To clarify the blood pressure-lowering effect of the fixed-dose combination (FDC) of an angiotensin receptor blocker (ARB) and diuretic agent in poorly controlled hypertensive patients, we intended a multicenter prospective observational study (Investigation for Normalized Blood pressure control with the Appropriate medication: INBA) by means of the sequential ambulatory blood pressure monitoring (ABPM).MethodsOne hundred and thirteen hypertensive patients who had not achieved the target BP control proposed in the guidelines with medication containing any ARB but without diuretic agents (54 men; mean age, 66 years old; mean office systolic/diastolic BP (SBP/DBP), 158/82 mmHg) were enrolled. Daytime and nighttime blood pressures were assessed with ABPM before and at 12 weeks after switching the ARB to the FDC of 50 mg of losartan, and 12.5 mg of hydrochlorothiazide (HCTZ).ResultsDaytime SBP/DBP (mean ± SD) decreased from 151 ± 14/88 ± 8 mmHg to 140 ± 11/82 ± 8 mmHg (P < 0.001, P < 0.001, respectively), and nocturnal SBP/DBP from 138 ± 18/78 ± 9 mmHg to 125 ± 14/72 ± 9 mmHg (P < 0.001, P < 0.001, respectively) during the 12 weeks treatment. Pulse rate did not change irrespective of the time window. Among various parameters (age, history of hypertension, body mass index (BMI), serum potassium, uric acid, estimated glomerular filtration rate, plasma B-type natriuretic peptide), BMI alone showed significant negative correlation with 12-weeks reduction in nocturnal SBP (r = -0.43, P < 0.05). No parameters correlated with reduction in daytime SBP during this period. Patients with BMI ≥ median (25.8 kg/m2) showed significantly greater reduction in nocturnal SBP for 12 weeks than patients with BMI < median (20.1 ± 15.6 mmHg vs 6.1 ± 10.9 mmHg, P < 0.001) although reduction in daytime SBP was comparable between the two groups (8.9 ± 13.5 mmHg vs 11.9 ± 12.7 mmHg).ConclusionsThe administration of the FDC of losartan/HCTZ lowers BP both in day- and nighttime, and the nocturnal antihypertensive potency is remarkable in obese patients.

show abstract

Section: Discussionsupporting

confidence: 89%

The Fixed-Dose Combination of Losartan/Hydrochlorothiazide Elicits Potent Blood Pressure Lowering During Nighttime in Obese Hypertensive Patients

et al. 2013

View full text Add to dashboard Cite

show abstract

“…A once-daily dose of long-acting amlodipine can control ambulatory blood pressure throughout a 24-hour period in elderly uncomplicated hypertensive patients with different nighttime blood pressure dipping 37. The ALPHABET study demonstrated that the effects of high-dose (10 mg) amlodipine on clinic, home, and ambulatory blood pressure control, and brain natriuretic peptide reduction were similar to the combination of losartan and hydrochlorothiazide 38. Furthermore, amlodipine may have additional protective benefits in not reducing nocturnal blood pressure to the extent that it accelerates brain ischemia in some hypertensive patients with marked nocturnal blood pressure reduction 39,40…”

Section: Discussionmentioning

confidence: 99%

Titration of amlodipine to higher doses: a comparison of Asian and Western experience

Kario¹,

Robbins²,

Jeffers³

2013

VHRM

Self Cite

View full text Add to dashboard Cite

In this retrospective analysis, data pooled from two Phase III/IV open-label Asian studies were used to quantify the additional blood pressure efficacy achieved when titrating amlodipine from 5 mg to 10 mg in mild/moderate hypertensive patients, and compared to data pooled from three Western studies. The primary efficacy end point was the change from baseline in sitting systolic blood pressure (SBP) and diastolic blood pressure (DBP) to the specified time point (4–8 weeks, depending on the trial). For the Asian analysis (n=174), both mean SBP and DBP were significantly decreased at the final visit (SBP −13.3 mmHg, 95% confidence interval [CI] −15.5 to −11.0; DBP −9.2 mmHg, 95% CI −10.6 to −7.8; both P<0.0001). These results were similar to the Western analysis (n=369; SBP −11.5 mmHg, 95% CI −13.1 to −10.0; DBP −6.3, 95% CI −7.1 to −5.5; both P<0.0001). In summary, titration of amlodipine from 5 mg to 10 mg significantly decreased both SBP and DBP in Asian patients with mild-to-moderate hypertension.

show abstract

“…16 It was also said in the article that the more beneficial for the reduction of UAE levels was the combination of the ARB with the diuretics. Our study was made with amlodipine and valsartan alone as monotherapy, so we prevented the effect of diuretics.…”

Section: Discussionmentioning

confidence: 99%

Amlodipine Seems To Be Superior to Valsartan in Decreasing Microalbuminuria in Newly Diagnosed Hypertensive Patients: A Novel Effect To Be Explained with Hyperfiltration?

Çakar

Karaman

et al. 2013

Renal Failure

View full text Add to dashboard Cite

Background: Microalbuminuria (MA) is common in hypertensive population and is a marker for endothelial dysfunction and a predictor of increased cardiovascular risk. A great body of data shows the importance of MA as a strong predictor of renal and cardiovascular disease (CVD) risk in hypertensive population. Aim: In this study, we aimed to compare the antialbuminuric effects of an angiotensin II receptor antagonist, valsartan, with a calcium channel blocker, amlodipine, in newly diagnosed hypertensive patients. Material and methods: Totally, 20 patients were recruited into the study. Patients were randomized to one of the following intervention protocols: An (a) angiotensin II receptor blocker (valsartan, 80-320 mg/day) or (b) calcium channel blocker (amlodipine, 5-10 mg/day), for 12 weeks immediately after baseline measurements. Ten patients were randomized into valsartan group and 10 patients into the amlodipine group. Twenty-four-hour urinary albumin excretion (UAE) levels of the patient groups were measured before treatment and on the 12th week. Results: Patients of the two groups were matched for age and body mass index. In the amlodipine group, baseline urine microalbumin levels were higher compared to valsartan group, although the difference was not statistically significant (p ¼ 0.082). At the 12th week, there was a significant decrease in urine microalbumin levels in the amlodipine group, but no significant change was observed in the valsartan group. Conclusion: Amlodipine seems to be superior to valsartan in decreasing UAE. To reduce cardiovascular risks, endothelial dysfunction, and microinflammation, these factors are taken into consideration while prescribing antihypertensive drugs in hypertensive patients.

show abstract

Differential effects of strict blood pressure lowering by losartan/hydrochlorothiazide combination therapy and high-dose amlodipine monotherapy on microalbuminuria: the ALPHABET study

Cited by 12 publications

References 38 publications

The Fixed-Dose Combination of Losartan/Hydrochlorothiazide Elicits Potent Blood Pressure Lowering During Nighttime in Obese Hypertensive Patients

The Fixed-Dose Combination of Losartan/Hydrochlorothiazide Elicits Potent Blood Pressure Lowering During Nighttime in Obese Hypertensive Patients

Titration of amlodipine to higher doses: a comparison of Asian and Western experience

Amlodipine Seems To Be Superior to Valsartan in Decreasing Microalbuminuria in Newly Diagnosed Hypertensive Patients: A Novel Effect To Be Explained with Hyperfiltration?

Contact Info

Product

Resources

About