Evaluation of losartan plus hydrochlorothiazide combination therapy against amlodipine monotherapy in patients of hypertension

Authors

  • Swati D. Sawant Department of Biochemistry, Dr. V. M. G. M. C., Solapur, Maharashtra, India
  • Sanjeevani M. Chawre Department of Pharmacology, D.Y. Patil Medical College and Hospital, Pune, Maharashtra, India
  • Kalpana S. Dudhal Department of Pharmacology, Lokmanya Tilak Municipal Medical College, Sion, Mumbai, Maharashtra, India
  • Amit A. Bansode Department of Pharmacology, Dr. V. M. G. M. C., Solapur, Maharashtra, India

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20194797

Keywords:

Microalbuminuria, Losartan plus hydrochorothiazide, Amlodipine, Blood pressure

Abstract

Background: Microalbuminuria has been shown to predict cardiovascular disease (CVD) in patients with hypertension. Recently the FDC of losartan and hydrochlorothiazide (HCTZ) has been reported to be effective for achieving a target BP level and also improvement in cardiovascular prognosis. The present study was conducted to compare effect of losartan plus hydrochlorothiazide combination therapy and high dose amlodipine monotherapy on blood pressure and microalbuminuria.

Methods: Total 184 patients with hypertension were randomly allocated to two groups. The patients in group 1 received Amlodipine 5 mg orally for first 4 weeks. The  patients  from  group  2  received  losartan  50  mg  orally  for  first  4  weeks. Patients  in  group  1  were  titrated  to  amlodipine  10  mg  orally  for next 4 weeks. The patients in group 2 were titrated to FDC of losartan (50 mg) plus HCTZ (12.5 mg) for next 4 weeks. Follow–up visits were scheduled at 4 weeks and 8 weeks. Pulse rate, sSBP and sDBP were estimated at each follow–up. Microalbuminuria was estimated at 8 weeks.

Results: There was no significant difference in mean change in sSBP, sDBP and pulse rate between two treatment groups (p>0.05). There was greater reduction in microalbuminuria in group 2 patients (p<0.0001). The adverse effects such as flushing and lower extremity oedema were significantly more in amlodipine group (p<0.05).

Conclusions: Losartan plus HCTZ has similar effect on BP, better safety profile and superior effect on microalbuminuria level  reduction.

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References

Kotchen TA. Hypertensive vascular disease. In: Lango DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, eds. Harrison’s principle of Internal Medicine, 18th edition, McGraw Hill, New York; 2012: 1688-1705.

Marma AK, Lloyd- Jones DM. Systemic examination of the updated Framingham heart study general cardiovascular risk profile. Circulation. 2009;120:384-90.

Chrysant SG, Chrysant GS. Effectiveness of lowering BP to prevent stroke versus to prevent coronary events. Am J Cardiol. 2010;106:825-9.

Parving HH. Microalbuminuria in essential hypertension and diabetes mellitus. J Hypertens Suppl. 1996;14(2):S89-93.

Kavagaci H, Sahin A, Ozdemir F. The effects of losartan & fosinopril in hypertensive type 2 diabetic patients. Diabetic Res Clin Pract. 2002;58:19-25.

Saruta T, Ogihara T, Matsuoka H, Suzuki H, Toki M, Hirayama Y, et al. Antihypertensive efficacy & safety of fixed–dose combination therapy with losartan plus hydrochlorothiazide in japanese patients with essential hypertension. Hypertens Res. 2007;30:729-39.

Oparil S, Abate N, Chen E, Creager MA, Galet V, Jia G, et al. A double-blind, randomized study evaluating losartan potassium monotherapy or in combination with hydrochlorothiazide vesus placebo in obese patients with hypertension. Curr Med Res Opin. 2008;24:1101-14.

Dahlof B, Devereux RB, Kjedsen SE, Julius S, Beevers G, de Faire U, et al. Cardiovascular morbidity in the Losartan Intervention for Endpoint Reduction in Hypertension study (LIFE): a randomized trial against atenolol. Lancet. 2002;359(9311):995-1003.

Bakris GL, Toto RD, McCullough PA, Rocha R, Purkayastha D, Davis P. Effects of different ACE inhibitor combinations on albuminuria: results of the GUARD study. Kidney Int. 2008;73:1303-9.

Eguchi K, Kario K, Hoshide Y, Hoshide S, Ishikawa J, Morinari M, et al. Comparison of valsartan &amlodepine on ambulatory & morning BP in hypertensive patients. AM J Hypertens. 2004;17:112-7.

Uno H, Ishikawa J, Hoshide S, Kabutoya T, Ishikawa S, Shimada K, et al. effects of strict blood pressure control by a long acting calcium channel blocker on brain natriuretic peptide & urinary albumin excretion rate in Japanese hypertensive patients. Hypetens Res. 2008;31:887-96.

Fogari R, Zoppi A, Malamani GD, Lusardi P, Destro M, Corradi L. Effects of Amlodipine vs Enalapril on Microalbuminuria in Hypertensive patients with Type II Diabetes. Clin Drug Investig. 1997;13(1):s42-9.

Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL jr., et al. seventh report of Joint Natinal Committee on Prevention, Detection, Evaluation, & Treatment of High blood pressure. Hypertension. 2003;42:1206-52

Wilson TW, Lacourcière Y, Barnes CC. The antihypertensive efficacy of losartan and amlodipine assessed with office and ambulatory blood pressure monitoring. Canadian Cozaar Hyzaar Amlodipine Trial Study Group. CMAJ. 1998;159(5):469-76.

Watanabe N, Kamei S, Ohkubo A, Yamanaka M, Ohsawa S, Makino K, et al. Urinary protein as measured with a pyrogallol red-molybdate complex, manually and in a Hitachi 726 automated analyzer. Clin Chem. 1986;32(8):1551-4.

Kalra S, Kalra B, Agrawal N. Combination therapy in hypertension: An update. Diabetol Metab Syndr. 2010;2(1):44.

Fukutomi M, Hoshide S, Eguchi K, Watanabe T, Shimada K, Kario K. Differential effects of strict blood pressure lowering by losartan/ hydrochlorothiazide combination therapy and high-dose amlodipine monotherapy on microalbuminuria: the ALPHABET study. J Am Soc Hypertens. 2012;6(1):73-82.

Phillips RA, Kloner RA, Grimm RH Jr, Weinberger M. The effects of amlodipine compared to losartan in patients with mild to moderately severe hypertension. J Clin Hypertens (Greenwich). 2003;5(1):17-23.

Fernández-Andrade C, Russo D, Iversen B, Zucchelli P, Aranda P, Guerra L, et al. Comparison of losartan and amlodipine in renally impaired hypertensive patients. Kidney Int Suppl. 1998;68:S120-4.

Ruilope LM, Malacco E, Khder Y, Kandra A, Bönner G, Heintz D. Efficacy and tolerability of combination therapy with valsartan plus hydrochlorothiazide compared with amlodipine monotherapy in hypertensive patients with other cardiovascular risk factors: the VAST study. Clin Ther. 2005;27(5):578-87.

Chung JW, Lee HY, Kim CH, Seung IW, Shin YW, Jeong MH, Cho MC, Oh BH. Losartan/Hydrochlorothiazide fixed combination versus amlodipine monotherapy in korean patients with mild to moderate hypertension. Korean Circ J. 2009;39(4):151-6.

Dahlöf B, Lindholm LH, Carney S, Pentikäinen PJ, Ostergren J. Main results of the losartan versus amlodipine (LOA) study on drug tolerability and psychological general well-being. LOA Study Group. J Hypertens. 1997;15(11):1327-35.

Volpe M, Junren Z, Maxwell T, Rodriguez A, Gamboa R, Gomez-Fernandez P, et al. CDSP-944 Study Group. Comparison of the blood pressure-lowering effects and tolerability of Losartan- and Amlodipine-based regimens in patients with isolated systolic hypertension. Clin Ther. 2003;25(5):1469-89.

Griffin KA, Bidani AK. Progression of renal disease: renoprotective specificity of renin-angiotensin system blockade. Clin J Am Soc Nephrol. 2006;1(5):1054-65.

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Published

2019-10-22

How to Cite

Sawant, S. D., Chawre, S. M., Dudhal, K. S., & Bansode, A. A. (2019). Evaluation of losartan plus hydrochlorothiazide combination therapy against amlodipine monotherapy in patients of hypertension. International Journal of Basic & Clinical Pharmacology, 8(11), 2528–2534. https://doi.org/10.18203/2319-2003.ijbcp20194797

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Original Research Articles