Key result
Amlodipine monotherapy significantly improved lipid profiles, whereas hydrochlorothiazide and ab initio amlodipine-hydrochlorothiazide combination therapy adversely affected total cholesterol, triglycerides, HDL, and LDL levels.
Why the study?
Does amlodipine and hydrochlorothiazide combination therapy improve or worsen lipid profiles compared to monotherapy in Nigerians with newly diagnosed essential hypertension?
RCT (n=90)
Open-label
Computer program-generated random numbers
Yes
Does amlodipine and hydrochlorothiazide combination therapy improve or worsen lipid profiles compared to monotherapy in Nigerians with newly diagnosed essential hypertension?
Answers are grounded in this paper and cite their sources.
May favor amlodipine monotherapy to limit lipid worsening; leaves open whether combination therapy adversely affects profiles in larger trials.
There is paucity of information regarding the effects of combination therapy with amlodipine and hydrochlorothiazide on lipid profiles in hypertensive Nigerians. Therefore, to evaluate whether this combination therapy would ameliorate or aggravate the known metabolic adversity of hydrochlorothiazide on lipid parameters, 90 male and female Nigerians aged 31-86 years with newly diagnosed uncomplicated essential hypertension (blood pressure > 160/90 ⤠180/120mmHg) were enrolled into a randomised 48-week study. Treatment was initiated in the patients, who were 30 each in amlodipine, hydrochlorothiazide and amlodipine-hydrochlorothiazide groups, with amlodipine 5mg, hydrochlorothiazide 25mg and amlodipine 5mg + hydrochlorothiazide 25mg, respectively. Body mass index, blood pressure and lipid profiles were evaluated at baseline as well as at the end of weeks 1, 3, 6, 12, 24, 36 and 48. The 3 regimens significantly (p<0.05) reduced blood pressure. At the end of week 48, mean male/female % significant decrease or increase in lipid parameters in amlodipine, hydrochlorothiazide and amlodipine-hydrochlorothiazide groups were, respectively: -4.3/-1.5, 2.8/3.7 and 2.6/2.5, p<0.0001 for total cholesterol; -7.2/-2.6, 5.3/5.6 and 6.6/6.2, p<0.0001 for triglyceride; 16.5/19.6, -12.0/-8.6 and -7.8/-8.4, p<0.0001 for high density lipoprotein cholesterol; -4.6/-3.0, 5.6/11.7 and 4.5/8.0, p<0.0001 for low density lipoprotein cholesterol. This study demonstrates that beyond reducing blood pressure, amlodipine and hydrochlorothiazide combination therapy has varied effects on lipid panel and it also suggests that, with regard to cardiovascular risk profile, it may be preferable to initiate treatment with a regimen of amlodipine to which hydrochlorothiazide is subsequently added, instead of a regimen of hydrochlorothiazide to which amlodipine is later added or a regimen of ab initio amlodipine-hydrochlorothiazide combination therapy.
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Iyalomhe et al. (2013) conducted an RCT in Essential hypertension (n=90). Amlodipine and Hydrochlorothiazide vs. Monotherapy vs Combination was evaluated on Percentage change in lipid parameters (total cholesterol, triglycerides, HDL, LDL) at 48 weeks (p=<0.0001). Amlodipine monotherapy significantly improved lipid profiles, whereas hydrochlorothiazide and ab initio amlodipine-hydrochlorothiazide combination therapy adversely affected total cholesterol, triglycerides, HDL, and LDL levels.
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