Ambulatory blood pressure response to triple therapy with an angiotensin-receptor blocker (ARB), calcium-channel blocker (CCB), and HCTZ versus dual therapy with an ARB and HCTZ
Daniel Duprez1, Keith Ferdinand2, Das Purkayastha3, Rita Samuel3, Richard Wright4
1University of Minnesota, Minneapolis, MN, 2Atlanta Clinical Research Centers, Atlanta, GA, 3Novartis Pharmaceuticals Corporation, East Hanover, NJ, 4Pacific Heart Institute, Santa Monica, CA, USA
Background: Stage 2 hypertension often requires combination antihypertensive therapy. Ambulatory blood pressure monitoring (ABPM) is a useful tool for assessing antihypertensive drugs and their combinations.
Objective: To compare the effect of a moderate dose of angiotensin receptor blocker/calcium channel blocker (ARB/CCB) combined with a diuretic versus a maximal dose of ARB with a diuretic on 24-hour ambulatory blood pressure monitoring (ABPM) and other derived ambulatory blood pressure (ABP) parameters.
Methods: The EXforge As compared to Losartan Treatment ABPM substudy was a randomized, double-blind, parallel-group, active-control, forced-titration study of patients with Stage 2 hypertension that compared the efficacy of initial treatment with valsartan/amlodipine 160/5 mg (n = 48) or losartan 100 mg (n = 36). At week 3, hydrochlorothiazide (HCTZ) 25 mg was added in both treatment groups. ABP was measured at baseline and at week 6. Additionaly, 24-hour ABP, nighttime (10 pm to 6 am) and daytime (6 am to 10 pm) ABP, and ABP load (percentage of readings above 140/90 mmHg) were determined.
Results: Eighty-four patients (48 ARB/CCB/HCTZ, 36 ARB/HCTZ) had ABPM at baseline and at week 6. Reductions of systolic/diastolic ABP were greater in the ARB/CCB/HCTZ group than in the ARB/HCTZ group for 24-hour mean ABP (–22.0/–13.3 versus –17.4/–8.1 mmHg), as well as nighttime ABP (–22.2/–13.3 versus –16.2/–7.4 mmHg), daytime ABP (–21.9/–13.0 versus –18.1/–8.6 mmHg), ABP in the last 4 hours of the dosing period (–21.5/–13.5 versus –17.0/–7.7 mmHg), and ABP load (21.7%/12.8% versus 30.8%/20.0%).
Conclusion: Initiating antihypertensive treatment with moderate doses of ARB/CCB with a diuretic is more effective in lowering nighttime and daytime ABP and reducing ABP load than a maximal dose of an ARB with a diuretic.
Keywords: antihypertensive drugs, ambulatory blood pressure, ambulatory blood pressure monitoring, combination therapy, valsartan, amlodipine, hydrochlorothiazide, losartan
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