Amlodipine-valsartan decreased central systolic blood pressure significantly more than amlodipine-atenolol (difference -4.00 mm Hg; 95% CI -7.10 to -0.90; P=0.013) in patients with hypertension.
RCT (n=393)
blinded endpoint
randomized
Yes
Does amlodipine-valsartan combination reduce central systolic blood pressure more effectively than amlodipine-atenolol combination in patients with essential hypertension resistant to amlodipine monotherapy?
In patients with essential hypertension resistant to amlodipine monotherapy, the combination of amlodipine and valsartan reduces central systolic blood pressure and augmentation index more effectively than amlodipine and atenolol.
Mean Difference: -4 (95% CI -7.1–-0.9)
Absolute Event Rate: -13.7% vs -9.7%
p-value: p=0.013
The beta-blocker atenolol is less effective than angiotensin-receptor blockers and calcium-channel blockers for reducing central blood pressure (BP). The trial was designed to determine whether the advantages of angiotensin-receptor blockers over atenolol remained significant when both were combined with the calcium-channel blocker amlodipine. A prospective, randomized, blinded endpoint (PROBE design) parallel group, multicenter trial including 393 patients with essential hypertension resistant to 4 weeks of 5 mg of amlodipine was set out. Central systolic BP, augmentation index (AIx; either rough or adjusted on heart rate), and carotid-to-femoral pulse wave velocity were measured with applanation tonometry (SphygmoCor) at inclusion and after 8 and 24 weeks of active treatment with an amlodipine-valsartan combination (5/80 mg and then 10/160 mg) or an amlodipine-atenolol combination (5/50 mg and then 10/100 mg). From baseline to week 24, central systolic BP decreased significantly more in the amlodipine-valsartan group (-13.70+/-1.15 mm Hg; P<0.0001) than in the amlodipine-atenolol group (-9.70+/-1.10 mm Hg; P<0.0001; difference: -4.00 mm Hg 95% CI: -7.10 to -0.90; P=0.013), despite similar changes in brachial systolic BP. The difference in rough AIx reduction was -6.5% (95% CI: -8.3 to -4.7; P<0.0001) in favor of amlodipine-valsartan. AIx adjusted on heart rate was significantly reduced in favor of amlodipine-valsartan (-2.8% 95% CI: -4.92 to -0.68; P<0.01). Heart rate decreased significantly more with amlodipine-atenolol (difference: -11 bpm 95% CI: -14 to -8 bpm; P<0.001). Pulse wave velocity decreased by 0.95 m/s in both groups with no significant difference. Differences in central systolic BP and rough AIx remained significant after adjustment to the changes in heart rate. The amlodipine-valsartan combination decreased central (systolic and pulse) pressure and AIx more than the amlodipine-atenolol combination.
Boutouyrie et al. (Tue,) conducted a rct in essential hypertension (n=393). amlodipine-valsartan combination vs. amlodipine-atenolol combination (5/50 mg and then 10/100 mg) was evaluated on change in central systolic BP from baseline to week 24 (MD -4.00 mm Hg, 95% CI -7.10 to -0.90, p=0.013). Amlodipine-valsartan decreased central systolic blood pressure significantly more than amlodipine-atenolol (difference -4.00 mm Hg; 95% CI -7.10 to -0.90; P=0.013) in patients with hypertension.