Key result
Triple therapy with azilsartan/amlodipine/hydrochlorothiazide 20/5/12.5 mg significantly reduced office diastolic/systolic blood pressure compared to dual therapy (-25.9/-41.4 vs -22.4/-34.5 mmHg).
Why the study?
Does triple therapy with azilsartan/amlodipine/hydrochlorothiazide reduce blood pressure more than dual therapy in Japanese patients with essential hypertension?
RCT (n=353)
Double-blind
Randomized
Does triple therapy with azilsartan/amlodipine/hydrochlorothiazide reduce blood pressure more than dual therapy in Japanese patients with essential hypertension?
Triple combination therapy with azilsartan, amlodipine, and hydrochlorothiazide provides superior blood pressure reduction compared to dual therapy in Japanese patients with essential hypertension.
Triple AZI/AML/HCTZ outperforms dual therapy for BP control with acceptable safety; extends RCT evidence for fixed-dose combinations in Japanese essential hypertension.
OBJECTIVE: The efficacy and safety of triple therapy with azilsartan (AZI), amlodipine besylate (AML), and hydrochlorothiazide (HCTZ) compared with dual therapy with AZI/AML or HCTZ monotherapy were evaluated in Japanese essential hypertensive patients in a double-blinded manner. PATIENTS AND METHODS: A total of 353 patients with office blood pressure (BP) of at least 150/95 mmHg were randomized to a 10-week treatment with AZI/AML/HCTZ 20/5/12.5 mg, AZI/AML/HCTZ 20/5/6.25 mg, AZI/AML 20/5 mg, HCTZ 12.5 mg, or HCTZ 6.25 mg. RESULTS: The mean change from baseline in office diastolic/systolic BPs at week 10 was -25.9/-41.4, -24.9/-38.6, and -22.4/-34.5 mmHg in the AZI/AML/HCTZ 20/5/12.5 mg, AZI/AML/HCTZ 20/5/6.25 mg, and AZI/AML 20/5 mg groups, respectively. AZI/AML/HCTZ 20/5/12.5 mg led to a significantly greater reduction in diastolic and systolic BP than the dual therapy. In addition, the change in home diastolic BP measured with telemetry devices showed a significant difference between the two triple therapy groups. The incidences of adverse events except dizziness postural were similar among the treatment groups in the triple therapy groups. CONCLUSION: Triple therapy with AZI/AML/HCTZ 20/5/12.5 mg shows a greater antihypertensive effect than the dual therapy and has acceptable safety profiles for Japanese essential hypertensive patients. It was also observed that home BP measurement by automated telemetry could detect changes in BP that were not detected in office BP measurement, although further investigation is needed.
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Rakugi et al. (2017) conducted an RCT in Essential hypertension (n=353). Azilsartan/amlodipine/hydrochlorothiazide vs. Azilsartan/amlodipine 20/5 mg or hydrochlorothiazide monotherapy was evaluated on Mean change from baseline in office diastolic/systolic blood pressure at week 10. Triple therapy with azilsartan/amlodipine/hydrochlorothiazide 20/5/12.5 mg significantly reduced office diastolic/systolic blood pressure compared to dual therapy (-25.9/-41.4 vs -22.4/-34.5 mmHg).
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