Key result
Losartan/hydrochlorothiazide and candesartan/amlodipine were equally effective in reducing blood pressure, with systolic blood pressure decreasing by 20.3 mmHg and 19.6 mmHg respectively after 4 months.
Why the study?
Does losartan/hydrochlorothiazide improve blood pressure reduction compared to candesartan/amlodipine in hypertensive patients uncontrolled on candesartan monotherapy?
RCT (n=36)
Open-label
Randomized
No
Does losartan/hydrochlorothiazide improve blood pressure reduction compared to candesartan/amlodipine in hypertensive patients uncontrolled on candesartan monotherapy?
Absolute Event Rate: -20.3% vs -19.6%
Losartan/hydrochlorothiazide is as effective as candesartan/amlodipine in reducing blood pressure for patients uncontrolled on ARB monotherapy, with a favorable metabolic safety profile.
Offers interchangeable ARB combinations post-monotherapy failure; confirms equivalence in this RCT.
In guidelines, a combination therapy of two or more antihypertensives is recommended for treatment of hypertension where monotherapy is ineffective. Although diuretics or calcium channel blockers are commonly used as add-ons to angiotensin receptor blocker (ARB), the most effective and safe combination has not been established. In this randomized 4-month study, the efficacy and safety were compared between an ARB/diuretics (losartan/hydrochlorothiazide [HCTZ]) combination and the most prescribed combination, ARB/calcium channel blocker (candesartan/amlodipine) in hypertensive patients for whom 8 mg/day of candesartan proved ineffective. After 36 patients were recruited and allocated into two groups, changes in blood pressure (BP) and laboratory values were analyzed in 31 patients: 16 patients received losartan (50 mg/day)/HCTZ (12.5 mg/day) (L/H group), and 15 patients received candesartan (8 mg/day)/amlodipine (5 mg/day) (C/A group) after 5 patients were withdrawn. After 4 months, L/H significantly (p<0.001) reduced mean systolic BP (SBP)/diastolic BP (DBP) from baseline 160/89 +/- 13/11 mmHg to 140/80 +/- 9/8 mmHg, and C/A reduced BP from 161/90 +/- 10/11 mmHg to 141/79 +/- 10/7 mmHg. The efficacy in reducing BP was similar between the two combination therapies. L/H significantly reduced serum potassium, but within the normal range, and did not increase serum uric acid or serum triglyceride. With L/H, the percentage of patients who attained the BP goal in SBP was higher in elderly patients than in younger patients. As L/H is more cost-effective than candesartan/amlodipine and has fewer adverse effects on uric acid and other metabolic parameters than diuretic monotherapy, it is concluded to be useful for the management of hypertension.
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Shimosawa et al. (2007) conducted an RCT in Hypertension (n=36). Losartan/Hydrochlorothiazide vs. Candesartan 8 mg / Amlodipine 5 mg per day was evaluated on Change in systolic blood pressure at 4 months. Losartan/hydrochlorothiazide and candesartan/amlodipine were equally effective in reducing blood pressure, with systolic blood pressure decreasing by 20.3 mmHg and 19.6 mmHg respectively after 4 months.
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