Effectiveness of Add-On Low-Dose Diuretics in Combination Therapy for Hypertension: Losartan/Hydrochlorothiazide vs. Candesartan/Amlodipine

Shimosawa, Tatsuo; Gohchi, Kengo; Yatomi, Yutaka; Fujita, Toshiro

doi:10.1291/hypres.30.831

Cited by 31 publications

(19 citation statements)

References 15 publications

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“…However, limited data were available on the combination drug in Japan, especially with regard to long-term treatment, large numbers of patients and its use in a clinical setting. [6][7][8] We organized a study group mainly consisting of clinical physicians in Miyazaki Prefecture in Japan (Preminent Assigned League in Miyazaki by Primary care physicians: PALM-1 study group), and evaluated the efficacy and safety of the fixed combination of losartan/HCTZ for patients with essential hypertension for 1 year.…”

Section: Introductionmentioning

confidence: 99%

One-year effectiveness and safety of open-label losartan/hydrochlorothiazide combination therapy in Japanese patients with hypertension uncontrolled with ARBs or ACE inhibitors

Kita

Yokota²,

Ichiki³

et al. 2010

Hypertens Res

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The long-term antihypertensive efficacy and safety of losartan/hydrochlorothiazide (HCTZ) combinations have not been appropriately evaluated in Japan. In this study, treated hypertensive patients taking angiotensin-receptor blocker (ARB) or angiotensin-converting enzyme inhibitor (ACEI) regimens not at blood pressure (BP) goals proposed by the Japanese Society of Hypertension (JSH) were switched to losartan/HCTZ combinations and followed for 1 year. Data analysis included 244 patients aged 64.5±10.7 years, 56% male, 27% with diabetes mellitus and 36% with dyslipidemia. Pre-switching BP 157±16/ 88 ± 10 mm Hg promptly decreased and maintained a steady state, reaching 132 ± 15/77 ± 9 mm Hg (Po0.001) 1 year later. After 1 year of treatment, 50% of patients cleared the goals of the JSH guideline for systolic BP and 79% for diastolic BP. Patients with maximal doses of ARBs tended to show larger decreases in BP (159±11/90±10 to 128±10/75±8 mm Hg, Po0.001, n¼32). Clinical and laboratory adverse events were reported for 29 patients (11%), but serious abnormalities were not observed. In particular, plasma levels of uric acid (UA) were well-maintained for 1 year, and significant decreases in UA were observed in patients with higher levels of UA (X7.0 mg dl À1 ). Losartan/HCTZ combinations showed strong and steady hypotensive abilities and acceptable safety and tolerability in patients currently not at BP goals with regimens including ARBs or ACEIs in Japan.

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Section: Introductionmentioning

confidence: 99%

One-year effectiveness and safety of open-label losartan/hydrochlorothiazide combination therapy in Japanese patients with hypertension uncontrolled with ARBs or ACE inhibitors

Kita

Yokota²,

Ichiki³

et al. 2010

Hypertens Res

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“…5,6 Therefore, salt restriction or combination therapy with diuretics is recommended to those who do not respond well with RAS inhibitors alone. [7][8][9] RAS regulates urinary excretion of water and sodium, thereby determining blood pressure. Hall et al 10 confirmed this chronic pressure natriuresis in dogs: both angiotensin II (AngII) and angiotensin-converting enzyme inhibitor, SQ-14225, altered the relationship between salt intake and blood pressure, thereby affecting the salt sensitivity of blood pressure.…”

Section: Introductionmentioning

confidence: 99%

Blockade of angiotensin II type-1 receptor increases salt sensitivity in Sprague–Dawley rats

et al. 2009

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This study determined the role of angiotensin II type-1 (AT1) receptor in the salt sensitivity of blood pressure. The mean arterial blood pressure (MAP) of Sprague-Dawley rats was monitored by radio telemetry and, after baseline measurements, rats were treated either with (1) vehicle, (2) AT1 receptor blocker (ARB) olmesartan (OLM, 100 nmol kg À1 h À1 , subcutaneously), (3) OLM with hydrochlorothiazide (HCTZ, 40 mg kg À1 day À1 , orally), (4) angiotensin II (AngII, 100 ng kg À1 min À1 , subcutaneously) or with (5) AngII with OLM. Rats were fed a 0.5% salt diet during the baseline and first 7 days of treatment period, and the diet was then switched to one containing 8% salt for another 7 days. Urinary samples were collected in a metabolic cage at the end of each period. MAP of the vehicle group did not change throughout the study. In AngII-infused rats, BP increased only when rats were fed an 8% salt diet. OLM and OLM with AngII significantly reduced MAP when rats were on a 0.5% salt diet, but not on an 8% salt diet, indicating an enhanced salt sensitivity by OLM. Co-treatment with HCTZ reduced the salt sensitivity of OLM. The urinary level of the oxidative stress marker was increased by an 8% salt diet and was not altered by either OLM alone or in combination with HCTZ. However, OLM attenuated the salt-induced renal NAD(P)H (nicotinamide adenine dinucleotide phosphate) oxidase activity. These results indicate that AT1 receptor blockade increases salt sensitivity, which is reversed by diuretics. We conclude that OLM and HCTZ could be a useful combination for reduction of blood pressure even under high salt intake without changes in urinary oxidative stress levels.

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“…39 In this study, adherence was substantially high in both therapy groups throughout the observation period (Table 2), which is in line with previous studies demonstrating that losartan and a combination of losartan and a small dose of HCTZ were well tolerated in hypertensive patients. [40][41][42] In addition, BP self-measurements at home might be useful in raising the adherence to hypertensive medications by improving patient motivation. 43 Combination therapy included more male subjects than high-dose therapy (Table 1).…”

Section: Discussionmentioning

confidence: 99%

Losartan/hydrochlorothiazide combination vs. high-dose losartan in patients with morning hypertension—a prospective, randomized, open-labeled, parallel-group, multicenter trial

2012

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on behalf of the MAPPY Study InvestigatorsThe treatment of morning hypertension has not been established. We compared the efficacy and safety of a losartan/ hydrochlorothiazide (HCTZ) combination and high-dose losartan in patients with morning hypertension. A prospective, randomized, open-labeled, parallel-group, multicenter trial enrolled 216 treated outpatients with morning hypertension evaluated by home blood pressure (BP) self-measurement. Patients were randomly assigned to receive a combination therapy of 50 mg losartan and 12.5 mg HCTZ (n¼109) or a high-dose therapy with 100 mg losartan (n¼107), each of which were administered once every morning. Primary efficacy end points were morning systolic BP (SBP) level and target BP achievement rate after 3 months of treatment. At baseline, BP levels were similar between the two therapy groups. Morning SBP was reduced from 150.3 ± 10.1 to 131.5 ± 11.5 mm Hg by combination therapy (Po0.001) and from 151.0 ± 9.3 to 142.5 ± 13.6 mm Hg by high-dose therapy (Po0.001). The morning SBP reduction was greater in the combination therapy group than in the high-dose therapy group (Po0.001). Combination therapy decreased evening SBP from 141.6±13.3 to 125.3±13.1 mm Hg (Po0.001), and high-dose therapy decreased evening SBP from 138.9 ± 9.9 to 131.4 ± 13.2 mm Hg (Po0.01). Although both therapies improved target BP achievement rates in the morning and evening (Po0.001 for both), combination therapy increased the achievement rates more than high-dose therapy (Po0.001 and Po0.05, respectively). In clinic measurements, combination therapy was superior to high-dose therapy in reducing SBP and improving the achievement rate (Po0.001 and Po0.01, respectively). Combination therapy decreased urine albumin excretion (Po0.05) whereas high-dose therapy reduced serum uric acid. Both therapies indicated strong adherence and few adverse effects (Po0.001). In conclusion, losartan/HCTZ combination therapy was more effective for controlling morning hypertension and reducing urine albumin than high-dose losartan.

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Effectiveness of Add-On Low-Dose Diuretics in Combination Therapy for Hypertension: Losartan/Hydrochlorothiazide vs. Candesartan/Amlodipine

Cited by 31 publications

References 15 publications

One-year effectiveness and safety of open-label losartan/hydrochlorothiazide combination therapy in Japanese patients with hypertension uncontrolled with ARBs or ACE inhibitors

One-year effectiveness and safety of open-label losartan/hydrochlorothiazide combination therapy in Japanese patients with hypertension uncontrolled with ARBs or ACE inhibitors

Blockade of angiotensin II type-1 receptor increases salt sensitivity in Sprague–Dawley rats

Losartan/hydrochlorothiazide combination vs. high-dose losartan in patients with morning hypertension—a prospective, randomized, open-labeled, parallel-group, multicenter trial

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