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Combination angiotensin-receptor blocker (ARB)/calcium channel blocker with HCTZ vs the maximal recommended dose of an ARB with HCTZ in patients with stage 2 hypertension: the exforge as compared to losartan treatment in stage 2 systolic hypertension (EXALT) study.
J Clin Hypertens (Greenwich). 2011 Aug; 13(8):588-97.JC

Abstract

This study compared the efficacy and safety of combination angiotensin-receptor blocker (ARB)/calcium-channel blocker (CCB) with hydrochlorothiazide (valsartan/amlodipine/HCTZ 160/5/2mg) vs maximal available combination doses of an ARB with HCTZ (losartan/HCTZ 100/25 mg) in the management of stage 2 hypertension. After 1 to 2 weeks of antihypertensive drug washout, patients with a mean sitting systolic blood pressure (MSSBP) of ≥ 160 mm Hg and <200 mm Hg were randomized to valsartan/amlodipine 160/5 mg (n = 241) or losartan 100 mg (n = 247). At week 3, HCTZ 25 mg was added to both treatments. The primary end point, reduction in MSSBP from baseline to week 6, was significantly greater in the valsartan/amlodipine group than in the losartan group (least-squares [LS] mean change, -31.8 mm Hg vs -26.4 mm Hg; P<.001). Additional reductions occurred after titrating to 320/10/25 mg at week 6 in the valsartan/amlodipine group and switching from losartan/HCTZ to valsartan/amlodipine/HCTZ (week 6, 160/5/25 mg; week 9, 320/10/25 mg) in the losartan group. Achievement of blood pressure <140/90 mm Hg also favored the valsartan/amlodipine group. Dizziness was the only adverse event reported in >5% of patients (5.4% valsartan/amlodipine group, 3.6% losartan group). Moderate doses of an ARB/CCB combination with HCTZ reduced blood pressure more effectively than the maximal dose of an ARB with HCTZ.

Authors+Show Affiliations

Pacific Heart Institute, Santa Monica, CA 90404, USA. rwright@pacificheart.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21806769

Citation

Wright, Richard F., et al. "Combination Angiotensin-receptor Blocker (ARB)/calcium Channel Blocker With HCTZ Vs the Maximal Recommended Dose of an ARB With HCTZ in Patients With Stage 2 Hypertension: the Exforge as Compared to Losartan Treatment in Stage 2 Systolic Hypertension (EXALT) Study." Journal of Clinical Hypertension (Greenwich, Conn.), vol. 13, no. 8, 2011, pp. 588-97.
Wright RF, Duprez D, Purkayastha D, et al. Combination angiotensin-receptor blocker (ARB)/calcium channel blocker with HCTZ vs the maximal recommended dose of an ARB with HCTZ in patients with stage 2 hypertension: the exforge as compared to losartan treatment in stage 2 systolic hypertension (EXALT) study. J Clin Hypertens (Greenwich). 2011;13(8):588-97.
Wright, R. F., Duprez, D., Purkayastha, D., Samuel, R., & Ferdinand, K. C. (2011). Combination angiotensin-receptor blocker (ARB)/calcium channel blocker with HCTZ vs the maximal recommended dose of an ARB with HCTZ in patients with stage 2 hypertension: the exforge as compared to losartan treatment in stage 2 systolic hypertension (EXALT) study. Journal of Clinical Hypertension (Greenwich, Conn.), 13(8), 588-97. https://doi.org/10.1111/j.1751-7176.2011.00492.x
Wright RF, et al. Combination Angiotensin-receptor Blocker (ARB)/calcium Channel Blocker With HCTZ Vs the Maximal Recommended Dose of an ARB With HCTZ in Patients With Stage 2 Hypertension: the Exforge as Compared to Losartan Treatment in Stage 2 Systolic Hypertension (EXALT) Study. J Clin Hypertens (Greenwich). 2011;13(8):588-97. PubMed PMID: 21806769.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Combination angiotensin-receptor blocker (ARB)/calcium channel blocker with HCTZ vs the maximal recommended dose of an ARB with HCTZ in patients with stage 2 hypertension: the exforge as compared to losartan treatment in stage 2 systolic hypertension (EXALT) study. AU - Wright,Richard F, AU - Duprez,Daniel, AU - Purkayastha,Das, AU - Samuel,Rita, AU - Ferdinand,Keith C, Y1 - 2011/07/14/ PY - 2011/8/3/entrez PY - 2011/8/3/pubmed PY - 2012/1/20/medline SP - 588 EP - 97 JF - Journal of clinical hypertension (Greenwich, Conn.) JO - J Clin Hypertens (Greenwich) VL - 13 IS - 8 N2 - This study compared the efficacy and safety of combination angiotensin-receptor blocker (ARB)/calcium-channel blocker (CCB) with hydrochlorothiazide (valsartan/amlodipine/HCTZ 160/5/2mg) vs maximal available combination doses of an ARB with HCTZ (losartan/HCTZ 100/25 mg) in the management of stage 2 hypertension. After 1 to 2 weeks of antihypertensive drug washout, patients with a mean sitting systolic blood pressure (MSSBP) of ≥ 160 mm Hg and <200 mm Hg were randomized to valsartan/amlodipine 160/5 mg (n = 241) or losartan 100 mg (n = 247). At week 3, HCTZ 25 mg was added to both treatments. The primary end point, reduction in MSSBP from baseline to week 6, was significantly greater in the valsartan/amlodipine group than in the losartan group (least-squares [LS] mean change, -31.8 mm Hg vs -26.4 mm Hg; P<.001). Additional reductions occurred after titrating to 320/10/25 mg at week 6 in the valsartan/amlodipine group and switching from losartan/HCTZ to valsartan/amlodipine/HCTZ (week 6, 160/5/25 mg; week 9, 320/10/25 mg) in the losartan group. Achievement of blood pressure <140/90 mm Hg also favored the valsartan/amlodipine group. Dizziness was the only adverse event reported in >5% of patients (5.4% valsartan/amlodipine group, 3.6% losartan group). Moderate doses of an ARB/CCB combination with HCTZ reduced blood pressure more effectively than the maximal dose of an ARB with HCTZ. SN - 1751-7176 UR - https://www.unboundmedicine.com/medline/citation/21806769/Combination_angiotensin_receptor_blocker__ARB_/calcium_channel_blocker_with_HCTZ_vs_the_maximal_recommended_dose_of_an_ARB_with_HCTZ_in_patients_with_stage_2_hypertension:_the_exforge_as_compared_to_losartan_treatment_in_stage_2_systolic_hypertension__EXALT__study_ L2 - https://doi.org/10.1111/j.1751-7176.2011.00492.x DB - PRIME DP - Unbound Medicine ER -