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

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