Key result
Losartan + HCTZ cuts central SBP ~8 mmHg more than bisoprolol + HCTZ.
Why the study?
Does a fixed-dose combination of losartan 100 mg + HCTZ 25 mg improve central blood pressure, brachial blood pressure, and arterial stiffness more effectively than bisoprolol 10 mg + HCTZ 25 mg in patients with moderate-to-severe hypertension over 6 months?
RCT (n=59)
Open-label
Randomized
No
Does a fixed-dose combination of losartan 100 mg + HCTZ 25 mg improve central blood pressure, brachial blood pressure, and arterial stiffness more effectively than bisoprolol 10 mg + HCTZ 25 mg in patients with moderate-to-severe hypertension over 6 months?
In patients with moderate-to-severe hypertension, losartan + HCTZ and bisoprolol + HCTZ (with stepped amlodipine/doxazosin) achieve comparable brachial and 24-hour blood pressure control, but losartan + HCTZ provides superior reduction in central systolic blood pressure and more favorable effects on arterial stiffness and augmentation index.
Answers are grounded in this paper and cite their sources.
Losartan + HCTZ may be preferred for central BP lowering when brachial control is equivalent; extends evidence of regimen-specific central effects in moderate-to-severe hypertension.
BACKGROUND: The aim of this study was to compare the antihypertensive efficacy of losartan 100 mg + hydrochlorothiazide (HCTZ) 25 mg versus bisoprolol 10 mg + HCTZ 25 mg and their influence on arterial stiffness and central blood pressure (BP). METHODS: Of 60 patients with a mean BP of 173.3 ± 1.7/98.4 ± 1.2 mmHg, 59 were randomized to losartan + HCTZ (n = 32) or bisoprolol + HCTZ (n = 27). Amlodipine was added if target BP was not achieved at 1 month, and doxazosin was added if target BP was not achieved after 3 months. Body mass index, office and 24-hour ambulatory BP, pulse wave velocity (carotid-femoral [PWVE] and radial [PWVM]), noninvasive central systolic BP, augmentation index (AIx), laboratory investigations, and electrocardiography were done at baseline and after 6 months of treatment. RESULTS: Losartan + HCTZ was as effective as bisoprolol + HCTZ, with target office BP achieved in 96.9% and 92.6% of patients and target 24-hour BP in 75% and 66.7% of patients, respectively, after 6 months. Effective treatment of BP led to significant lowering of central systolic BP, but this was decreased to a significantly (P < 0.05) greater extent by losartan + HCTZ (-23.0 ± 2.3 mmHg) than by bisoprolol + HCTZ (-15.4 ± 2.9 mmHg) despite equal lowering of brachial BP. Factors correlated with central systolic BP and its lowering differed between the treatment groups. Losartan + HCTZ did not alter arterial stiffness patterns significantly, but bisoprolol + HCTZ significantly increased AIx. We noted differences in ΔPWVE, ΔPWVM, and ΔAIx between the groups in favor of losartan + HCTZ. Decreased heart rate was associated with higher central systolic BP and AIx in the bisoprolol + HCTZ group, but was not associated with increased AIx in the losartan + HCTZ group. CONCLUSION: Although both treatments decreased both office and 24-hour BP, losartan + HCTZ significantly decreased central systolic BP and had a more positive influence on pulse wave velocity, with a less negative effect of decreased heart rate on AIx and central systolic BP.
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Radchenko et al. (2013) conducted an RCT in Moderate-to-severe essential arterial hypertension (n=59). Fixed-dose combination of losartan + hydrochlorothiazide (HCTZ) vs. Nonfixed combination of bisoprolol 10 mg once daily + HCTZ 25 mg once daily (with identical stepped-care addition of amlodipine and doxazosin) was evaluated on Decrease in central systolic blood pressure at 6 months (p=<0.05). Losartan + HCTZ reduced central systolic BP to a significantly greater extent (-23.0 vs -15.4 mmHg, P<0.05) than bisoprolol + HCTZ despite similar brachial BP control.
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