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Randomized study to compare valsartan +/- HCTZ versus amlodipine +/- HCTZ strategies to maximize blood pressure control.
- Source :
-
Vascular health and risk management [Vasc Health Risk Manag] 2009; Vol. 5, pp. 883-92. Date of Electronic Publication: 2009 Nov 02. - Publication Year :
- 2009
-
Abstract
- Objective: Delays in achieving blood pressure (BP) control may increase morbidity and mortality in patients with hypertension. Thus, deciding which antihypertensive agent to use and at what dosage, in addition to determining when to initiate combination therapy and which agents to combine, is important for achieving BP control.<br />Methods: This randomized, double-blind, 14-week study was conducted to compare the efficacy and tolerability of various doses of valsartan +/- hydrochlorothiazide (HCTZ) versus amlodipine +/- HCTZ for maximizing BP control in 1,285 patients with uncontrolled hypertension. Patients with stage 1 hypertension and naïve to antihypertensive therapy (33.9%) started valsartan 160 mg or amlodipine 5 mg. Treatment-naïve patients with stage 2 hypertension (13.5%) or those uncontrolled on current antihypertensive monotherapy (52.6%) started valsartan 160 mg/HCTZ 12.5 mg or amlodipine 10 mg. At weeks 4, 8, and 11, patients not achieving BP control were up-titrated (maximum: valsartan 320 mg/HCTZ 25 mg, amlodipine 10 mg/HCTZ 25 mg).<br />Results: At study end, 78.8% of patients on valsartan +/- HCTZ were controlled (BP <140/90 mmHg) and still on study medication versus 67.8% on amlodipine +/- HCTZ (P < 0.0001). Amlodipine-treated patients had a higher incidence of peripheral edema (22.4% vs 2.2%) and associated discontinuations (7.3% vs <1%). Initiating therapy earlier with valsartan/HCTZ, rather than titrating monotherapy to its maximum dose before adding a second agent, was superior to amlodipine monotherapy or amlodipine +/- HCTZ for achieving BP control, and avoided excessive treatment adjustments and maintained tolerability.
- Subjects :
- Adult
Aged
Amlodipine adverse effects
Angiotensin II Type 1 Receptor Blockers adverse effects
Antihypertensive Agents adverse effects
Calcium Channel Blockers adverse effects
Diuretics adverse effects
Double-Blind Method
Drug Therapy, Combination
Europe
Female
Humans
Hydrochlorothiazide adverse effects
Hypertension physiopathology
Male
Middle Aged
South America
Tetrazoles adverse effects
Time Factors
Treatment Outcome
Valine adverse effects
Valine therapeutic use
Valsartan
Amlodipine therapeutic use
Angiotensin II Type 1 Receptor Blockers therapeutic use
Antihypertensive Agents therapeutic use
Blood Pressure drug effects
Calcium Channel Blockers therapeutic use
Diuretics therapeutic use
Hydrochlorothiazide therapeutic use
Hypertension drug therapy
Tetrazoles therapeutic use
Valine analogs & derivatives
Subjects
Details
- Language :
- English
- ISSN :
- 1178-2048
- Volume :
- 5
- Database :
- MEDLINE
- Journal :
- Vascular health and risk management
- Publication Type :
- Academic Journal
- Accession number :
- 19898644
- Full Text :
- https://doi.org/10.2147/vhrm.s8062