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Am J Hypertens. 2019 May 10. pii: hpz050. doi: 10.1093/ajh/hpz050. [Epub ahead of print]

Comparison of 24 hours Ambulatory Central Blood Pressure Reduction Efficacy between Fixed Amlodipine or Up-titrated Hydrochlorothiazide plus Losartan : The K-Central Study.

Author information

1
Division of Cardiology, Department of Internal Medicine, St. Paul's Hospital, Catholic University, Seoul, Korea.
2
Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
3
Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul, Korea.
4
Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University, Seoul, Korea.
5
Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
6
Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea.
7
Division of Cardiology, Department of Internal Medicine, Bundang Seoul National University Hospital, Seongnam, Korea.
8
Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea.
9
Division of Cardiology, Department of Internal Medicine, Hanyang University Hospital, Seoul, Korea.
10
Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea.
11
Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea.
12
Division of Cardiology, Department of Internal Medicine, Gil Hospital, Gachon University, Incheon, Korea.
13
Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea.
14
Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Pusan, Korea.
15
Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic University, Seoul, Korea.
16
Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea.
17
Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.
18
Division of Cardiology, Department of Internal Medicine, Yeungnam University Hospital, Daegu, Korea.

Abstract

OBJECTIVE:

To evaluate non-inferiority of office mean systolic blood pressure (BP) reduction efficacy and superiority of 24 hours ambulatory central BP reduction efficacy between losartan combined with fixed dose amlodipine (L/A group) and dose up-titrated hydrochlorothiazide (L/H group) according to office BP.

METHODS:

We conducted a prospective, randomized, double-blind multicenter trial in 231 hypertensive patients (mean age=59.2±12.2 years). Patients received losartan 50 mg monotherapy for 4 weeks, followed by additional use of amlodipine 5 mg or hydrochlorothiazide 12.5 mg for 20 weeks after randomization. The patients who did not achieve the BP goal after 4 weeks' randomization received an increased dose of 100 mg/5 mg for the L/A group and 100 mg/25 mg for L/H group respectively. The 24 hours ambulatory central BP was measured at baseline and after 20 weeks' treatment.

RESULTS:

Office mean systolic BP reduction of L/A group was not inferior to L/H group after 4 weeks' treatment (-17.6±13.3 vs. -14.4±12.6 mmHg, p=0.0863) and was not significantly different after 20 weeks' treatment. (-15.7±14.0 vs. -14.7±15.1 mmHg, p=0.6130) The 24 hours ambulatory central systolic BP was significantly more reduced in the L/A group compared with that in the L/H group after 20 weeks' treatment (-9.37±10.67 vs. -6.28±10.50 mmHg, p=0.0407). The 24 hours ambulatory central systolic BP at the completion of the study and its reduction magnitude were independently associated with reductions in aortic pulse wave velocity (aPWV), pulse pressure, and wave reflection magnitude.

CONCLUSION:

Office systolic BP reduction with L/A was not inferior to L/H after 4 week's treatment. The combination of losartan and amlodipine was more favorable in 24 hours ambulatory central hemodynamics beyond BP-lowering efficacy than the combination of losartan and hydrochlorothiazide, regardless of office BP.

KEYWORDS:

amlodipine; central blood pressure; combination; hydrochlorothiazide; losartan

PMID:
31099387
DOI:
10.1093/ajh/hpz050

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