Valsartan addition to amlodipine is more effective than losartan addition in hypertensive patients inadequately controlled by amlodipine

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Authors: Roberto Fogari, Amedeo Mugellini, Paola Preti, et al

Published Date February 2010 Volume 2010:6 Pages 87 - 93

DOI: http://dx.doi.org/10.2147/VHRM.S9404

Roberto Fogari, Amedeo Mugellini, Paola Preti, Annalisa Zoppi, Giuseppe Derosa

Department of Internal Medicine and Therapeutics, Centro Ipertensione e Fisiopatologia Cardiovascolare, University of Pavia, Pavia, Italy

Introduction: This study evaluated the effects on blood pressure (BP) of valsartan 160 mg or losartan 100 mg addition to amlodipine 5 mg in hypertensive patients.

Methods: 221 patients with inadequately controlled BP (DBP ≥ 90 mmHg) after 4 weeks of treatment with amlodipine 5 mg were randomized to receive losartan/amlodipine combination therapy or valsartan/amlodipine combination therapy for 4 weeks in a cross-over study design. At the end of the wash-out period and of each treatment period, clinic and ambulatory BP measurements were recorded.

Results: 166 patients completed the study. Both combination treatments induced a greater ambulatory BP reduction than did monotherapy. However, the further mean reductions in BP versus monotherapy were significantly greater with the valsartan/amlodipine combination (SBP/DBP: –7.9 ± 3.4/–6.5 ± 2.6 mmHg for 24-hour, –8.0 ± 3.4/–6.6 ± 2.7 mmHg for daytime; –7.7 ± 3.3/–6.4 ± 2.7 mmHg for nighttime) than with the losartan/amlodipine combination (SBP/DBP: –5.5 ± 2.8/–4.2 ± 2.1 mmHg for 24-hour, –5.7 ± 2.9/–4.4 ± 2.2 mmHg for daytime; –4.8 ± 2.8/–3.7 ± 2.2 mmHg for nighttime; P < 0.01 vs valsartan/amlodipine). The incidence of adverse events with valsartan/amlodipine (8%) and losartan/amlodipine (9%) was lower than that observed with amlodipine monotherapy (17%; P < 0.05 vs combinations).

Conclusion: Valsartan 160 mg plus amlodipine 5 mg produced greater BP reductions than losartan 100 mg plus amlodipine 5 mg.

Keywords: angiotensin receptor blocker, ambulatory blood pressure monitoring, valsartan, losartan, amlodipine, combination therapy