Efficacy, tolerability, and effects on quality of life of losartan, alone or with hydrochlorothiazide, versus amlodipine, alone or with hydrochlorothiazide, in patients with essential hypertension

Oparil, S.; Barr, Eliav; Elkins, Michelle; Liss, Charles L.; Vrecenak, Arthur; Edelman, Jonathan M.

doi:10.1016/s0149-2918(96)80212-8

Cited by 73 publications

(46 citation statements)

References 11 publications

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“…This assertion is supported by findings of a substudy of LIFE in hypertensive patients with LVH in which losartan was superior to the beta blocker atenolol in reducing the risk of cardiovascular complications of ISH, particularly stroke. Losartan's documented CV outcomes benefits in the ISH cohort of the LIFE study 76 and its excellent tolerability (alone or in combination with HCTZ) compared with other principal classes of antihypertensive agents, as consistently reproduced in different studies and populations, 72,[87][88][89][90] are likely to have important therapeutic ramifications for the management of SBP. A high degree of tolerability is especially important with respect to patients with systolic hypertension since these patients often require more than one antihypertensive agent to attain the target blood pressures.…”

Section: Discussionmentioning

confidence: 88%

“…72 In several clinical trials, losartan has been shown to be better tolerated than many other types of antihypertensive agents, including calcium channel blockers, ACE inhibitors, and beta blockers, particularly with respect to oedema, cough, and fatigue. [87][88][89][90] In an analysis of 2900 hypertensive patients enrolled in double-blind trials, losartan alone or losartan in combination with HCTZ was well tolerated, with a similar percentage of patients in losartan-treated and placebo-treated patients reporting clinical adverse experiences. 72 Similarly, in patients with ISH, the tolerability of losartan was also found to be similar to placebo and superior to amlodipine or atenolol.…”

Section: Tolerability and Compliancementioning

confidence: 99%

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Treatment of systolic hypertension: spotlight on recent studies with angiotensin II antagonists

Volpe

2004

J Hum Hypertens

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Systolic blood pressure has a continuous, graded, strong, independent, and aetiologically significant relationship to mortality from coronary heart disease, stroke, and all cardiovascular diseases, as well as to all-cause mortality and life expectancy. Angiotensin II (AII) may be intimately involved in the pathogenesis of systolic hypertension through multiple mechanisms, including decreasing the elastin content and increasing the collagen content of the arterial wall, thickening and fibrotic remodelling of the vascular intima, and proliferating smooth muscle cells in the arterial wall, resulting in increased thickness, stiffening, and partial loss of contractility. AII antagonists may therefore offer hitherto unrecognized benefits ( independent of blood pressure) on age-related vascular damage and provide particular benefits in patients with systolic hypertension. Recent evidence has demonstrated that losartan offers cardiovascular outcomes benefits in isolated systolic hypertension ( ISH) associated with an excellent tolerability profile. This, in patients with ISH, AII antagonists more facilitate systolic BP control, providing cardiovascular protection and offering an excellent risk-benefit profile

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Section: Discussionmentioning

confidence: 88%

Section: Tolerability and Compliancementioning

confidence: 99%

Treatment of systolic hypertension: spotlight on recent studies with angiotensin II antagonists

Volpe

2004

J Hum Hypertens

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“…5 The present study sought to assess the antihypertensive efficacy and goal BP attainment rate with the recommended starting dose of olmesartan medoxomil, compared with that of the most widely prescribed antihypertensive agent, amlodipine. Although other ARBs have been compared with amlodipine in clinical trials, [20][21][22][23] the studies focused primarily on the absolute reduction in BP between the two agents and not on their ability to achieve a specific BP goal. Further, our study utilized ABPM and assessed the efficacy of these agents in attaining the rigorous control rates of SBP o130 mmHg and DBP o85 mmHg, thus providing robust data with which to evaluate the comparative efficacy of olmesartan medoxomil and amlodipine.…”

Section: Discussionmentioning

confidence: 99%

Antihypertensive efficacy and safety of olmesartan medoxomil compared with amlodipine for mild-to-moderate hypertension

Chrysant

Marbury

Robinson³

2003

J Hum Hypertens

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The antihypertensive efficacy of the angiotensin II receptor blocker olmesartan medoxomil has been shown to compare favourably with that of other antihypertensive agents. This randomized, double-blind study compared the antihypertensive efficacy of the starting dose of olmesartan medoxomil with that of the calcium channel blocker amlodipine besylate (amlodipine) in subjects with mild-to-moderate hypertension. Following a 4-week, single-blind, placebo run-in period, 440 subjects aged X18 years were randomized to the starting dose of olmesartan medoxomil (20 mg/day), amlodipine (5 mg/day), or placebo for 8 weeks. Subjects were evaluated by 24-h ambulatory blood pressure monitoring (ABPM) and by seated cuff blood pressure (BP) measurements at trough. The primary end point was the change from baseline in mean 24-h diastolic blood pressure (DBP) by ABPM at Week 8. Secondary end points included change from baseline in mean 24-h ambulatory systolic blood pressure (SBP) at 8 weeks, change from baseline in mean seated trough cuff DBP and SBP measurements, and response and control rates for DBP o90 and o85 mmHg. Control rates for SBP o140 and o130 mmHg were also calculated. Olmesartan medoxomil and amlodipine produced significantly greater reductions in ambulatory and seated DBP and SBP compared with placebo. Mean reductions in ambulatory and seated BP were similar between the two active agents; however, in the olmesartan medoxomil group, significantly more patients achieved the SBP goal of o130 mmHg and the DBP goal of o85 mmHg. Both drugs were well tolerated at the recommended starting dose. Although amlodipine was associated with a higher incidence of oedema, this did not reach statistical significance. Olmesartan medoxomil is an effective antihypertensive agent, with BPlowering efficacy at the starting dose similar to that of amlodipine, and is associated with more patients achieving the rigorous BP goals of SBP o130 mmHg and DBP o85 mmHg.

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“…4 Clinical trials have shown that administration of LOS alone lowers blood pressure, and is well tolerated in individuals with hypertension. [5][6][7][8] Furthermore, LOS was found to have beneficial effects on renal and cardiovascular outcomes independent of its antihypertensive function. 9,10 Thiazide diuretics such as hydrochlorothiazide (HCTZ) have also been used for the treatment of hypertension and affect renal tubular mechanisms of electrolyte reabsorption, directly increasing the excretion of Na + and Cl À .…”

Section: Introductionmentioning

confidence: 99%

Mechanism underlying the efficacy of combination therapy with losartan and hydrochlorothiazide in rats with salt-sensitive hypertension

et al. 2011

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Although thiazide diuretics are commonly used to supplement angiotensin receptor blockers for treatment of hypertension, the mechanism underlying the therapeutic effects of this drug combination remains unclear. We investigated the antihypertensive and cardioprotective effects of combination therapy with losartan (LOS) and hydrochlorothiazide (HCTZ), in comparison with those of either drug alone, in Dahl salt-sensitive hypertensive rats. Rats fed a high-salt diet from 6 weeks of age were treated with LOS, HCTZ, both drugs (COMB) and vehicle from 6 to 11 weeks. The salt-induced increase in systolic blood pressure was attenuated moderately by LOS and to a greater extent by HCTZ and COMB. Left ventricular (LV) hypertrophy and fibrosis, diastolic dysfunction, as well as angiotensin-converting enzyme and angiotensin II type 1A (AT 1A ) receptor gene expression were attenuated similarly by LOS and HCTZ and more so by COMB. LOS downregulated expression of the AT 1A receptor gene, without affecting that of the AT 2 receptor gene, in the aorta. In contrast, neither HCTZ nor COMB affected aortic expression of the AT 1A receptor gene, but both markedly upregulated that of the AT 2 receptor gene. The salt-induced decrease in the plasma concentration of nitric oxide metabolites was attenuated substantially by LOS and abolished by both HCTZ and COMB. In conclusion, the combination of LOS and HCTZ attenuated hypertension, as well as LV remodeling and diastolic dysfunction, more effectively than did LOS or HCTZ alone in rats with salt-sensitive hypertension. Modulation of the cardiac and vascular renin-angiotensin system may have contributed to these beneficial effects of the drug combination.

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Efficacy, tolerability, and effects on quality of life of losartan, alone or with hydrochlorothiazide, versus amlodipine, alone or with hydrochlorothiazide, in patients with essential hypertension

Cited by 73 publications

References 11 publications

Treatment of systolic hypertension: spotlight on recent studies with angiotensin II antagonists

Treatment of systolic hypertension: spotlight on recent studies with angiotensin II antagonists

Antihypertensive efficacy and safety of olmesartan medoxomil compared with amlodipine for mild-to-moderate hypertension

Mechanism underlying the efficacy of combination therapy with losartan and hydrochlorothiazide in rats with salt-sensitive hypertension

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