March 16, 2005Journal of Hypertension
Comparison of antihypertensive effects of an angiotensin-converting enzyme inhibitor, a calcium antagonist and a diuretic in patients with hypertension not controlled by angiotensin receptor blocker monotherapy
Key result
Adding amlodipine or chlorthalidone to valsartan reduced 24-h ambulatory blood pressure by approximately 6/3.5 mmHg more than adding benazepril (P<0.05).
Why the study?
Does the addition of amlodipine or chlorthalidone reduce blood pressure more than the addition of benazepril in patients with hypertension uncontrolled by valsartan monotherapy?
Population
64 adults with hypertension not controlled by valsartan 160 mg once daily, mean age 48.2, 50% male.
Comparison
Amlodipine 5 mg once daily or chlorthalidone… vs Benazepril 20 mg once daily added to background…
Design
RCT, Allocated randomly to two groups, then assigned randomly to treatment in…
Follow-up
5 weeks per treatment period
Authors
Discussion
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Implication
Supports preferring diuretic or Ca antagonist over ACEI addition to ARB; leaves open optimal combinations in resistant hypertension.
Study Design
Type
RCT (n=64)
Randomization
randomly
Structured PICO
Does the addition of amlodipine or chlorthalidone reduce blood pressure more than the addition of benazepril in patients with hypertension uncontrolled by valsartan monotherapy?
P
Population
64 adults (mean age 48.2 years, 50% female) with hypertension uncontrolled by valsartan 160 mg once daily, followed in a crossover design for two 5-week periods.
I
Intervention
Amlodipine 5 mg once daily or chlorthalidone 12.5 mg once daily added to background valsartan 160 mg once daily for 5 weeks.
C
Comparator
Benazepril 20 mg once daily added to background valsartan 160 mg once daily for 5 weeks.
O
Outcome
Change in average 24-hour ambulatory blood pressure at the end of the 5-week treatment period.surrogate
Main Result
Effect estimate: 6/3.5 mmHg greater reduction
p-value: p=< 0.05
In patients with hypertension uncontrolled by ARB monotherapy, adding a calcium channel blocker or a diuretic provides superior blood pressure reduction compared to adding an ACE inhibitor.
Cite This Study
Stergiou et al. (2005) conducted an RCT in hypertension not controlled by angiotensin receptor blocker monotherapy (n=64). Amlodipine or chlorthalidone vs. benazepril 20 mg once daily was evaluated on average 24-h ambulatory blood pressure (6/3.5 mmHg greater reduction, p=< 0.05). Adding amlodipine or chlorthalidone to valsartan reduced 24-h ambulatory blood pressure by approximately 6/3.5 mmHg more than adding benazepril (P<0.05).