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Ambulatory blood pressure response to triple therapy with an angiotensin-receptor blocker (ARB), calcium-channel blocker (CCB), and HCTZ versus dual therapy with an ARB and HCTZ.
Vasc Health Risk Manag. 2011; 7:701-8.VH

Abstract

BACKGROUND

Stage 2 hypertension often requires combination antihypertensive therapy. Ambulatory blood pressure monitoring (ABPM) is a useful tool for assessing antihypertensive drugs and their combinations.

OBJECTIVE

To compare the effect of a moderate dose of angiotensin receptor blocker/calcium channel blocker (ARB/CCB) combined with a diuretic versus a maximal dose of ARB with a diuretic on 24-hour ambulatory blood pressure monitoring (ABPM) and other derived ambulatory blood pressure (ABP) parameters.

METHODS

The EXforge As compared to Losartan Treatment ABPM substudy was a randomized, double-blind, parallel-group, active-control, forced-titration study of patients with Stage 2 hypertension that compared the efficacy of initial treatment with valsartan/amlodipine 160/5 mg (n = 48) or losartan 100 mg (n = 36). At week 3, hydrochlorothiazide (HCTZ) 25 mg was added in both treatment groups. ABP was measured at baseline and at week 6. Additionaly, 24-hour ABP, nighttime (10 pm to 6 am) and daytime (6 am to 10 pm) ABP, and ABP load (percentage of readings above 140/90 mmHg) were determined.

RESULTS

Eighty-four patients (48 ARB/CCB/HCTZ, 36 ARB/HCTZ) had ABPM at baseline and at week 6. Reductions of systolic/diastolic ABP were greater in the ARB/CCB/ HCTZ group than in the ARB/HCTZ group for 24-hour mean ABP (-22.0/-13.3 versus -17.4/-8.1 mmHg), as well as nighttime ABP (-22.2/-13.3 versus -16.2/-7.4 mmHg), daytime ABP (-21.9/-13.0 versus -18.1/-8.6 mmHg), ABP in the last 4 hours of the dosing period (-21.5/-13.5 versus -17.0/-7.7 mmHg), and ABP load (21.7%/12.8% versus 30.8%/20.0%).

CONCLUSION

Initiating antihypertensive treatment with moderate doses of ARB/CCB with a diuretic is more effective in lowering nighttime and daytime ABP and reducing ABP load than a maximal dose of an ARB with a diuretic.

Authors+Show Affiliations

Cardiovascular Division, Universityof Minnesota, 420 Delaware St SE, MMC 508, Minneapolis, MN 55455, USA. dupre007@umn.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

22174580

Citation

Duprez, Daniel, et al. "Ambulatory Blood Pressure Response to Triple Therapy With an Angiotensin-receptor Blocker (ARB), Calcium-channel Blocker (CCB), and HCTZ Versus Dual Therapy With an ARB and HCTZ." Vascular Health and Risk Management, vol. 7, 2011, pp. 701-8.
Duprez D, Ferdinand K, Purkayastha D, et al. Ambulatory blood pressure response to triple therapy with an angiotensin-receptor blocker (ARB), calcium-channel blocker (CCB), and HCTZ versus dual therapy with an ARB and HCTZ. Vasc Health Risk Manag. 2011;7:701-8.
Duprez, D., Ferdinand, K., Purkayastha, D., Samuel, R., & Wright, R. (2011). Ambulatory blood pressure response to triple therapy with an angiotensin-receptor blocker (ARB), calcium-channel blocker (CCB), and HCTZ versus dual therapy with an ARB and HCTZ. Vascular Health and Risk Management, 7, 701-8. https://doi.org/10.2147/VHRM.S25743
Duprez D, et al. Ambulatory Blood Pressure Response to Triple Therapy With an Angiotensin-receptor Blocker (ARB), Calcium-channel Blocker (CCB), and HCTZ Versus Dual Therapy With an ARB and HCTZ. Vasc Health Risk Manag. 2011;7:701-8. PubMed PMID: 22174580.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ambulatory blood pressure response to triple therapy with an angiotensin-receptor blocker (ARB), calcium-channel blocker (CCB), and HCTZ versus dual therapy with an ARB and HCTZ. AU - Duprez,Daniel, AU - Ferdinand,Keith, AU - Purkayastha,Das, AU - Samuel,Rita, AU - Wright,Richard, Y1 - 2011/11/24/ PY - 2011/12/17/entrez PY - 2011/12/17/pubmed PY - 2012/7/10/medline KW - ambulatory blood pressure KW - ambulatory blood pressure monitoring KW - amlodipine KW - antihypertensive drugs KW - combination therapy KW - hydrochlorothiazide KW - losartan KW - valsartan SP - 701 EP - 8 JF - Vascular health and risk management JO - Vasc Health Risk Manag VL - 7 N2 - BACKGROUND: Stage 2 hypertension often requires combination antihypertensive therapy. Ambulatory blood pressure monitoring (ABPM) is a useful tool for assessing antihypertensive drugs and their combinations. OBJECTIVE: To compare the effect of a moderate dose of angiotensin receptor blocker/calcium channel blocker (ARB/CCB) combined with a diuretic versus a maximal dose of ARB with a diuretic on 24-hour ambulatory blood pressure monitoring (ABPM) and other derived ambulatory blood pressure (ABP) parameters. METHODS: The EXforge As compared to Losartan Treatment ABPM substudy was a randomized, double-blind, parallel-group, active-control, forced-titration study of patients with Stage 2 hypertension that compared the efficacy of initial treatment with valsartan/amlodipine 160/5 mg (n = 48) or losartan 100 mg (n = 36). At week 3, hydrochlorothiazide (HCTZ) 25 mg was added in both treatment groups. ABP was measured at baseline and at week 6. Additionaly, 24-hour ABP, nighttime (10 pm to 6 am) and daytime (6 am to 10 pm) ABP, and ABP load (percentage of readings above 140/90 mmHg) were determined. RESULTS: Eighty-four patients (48 ARB/CCB/HCTZ, 36 ARB/HCTZ) had ABPM at baseline and at week 6. Reductions of systolic/diastolic ABP were greater in the ARB/CCB/ HCTZ group than in the ARB/HCTZ group for 24-hour mean ABP (-22.0/-13.3 versus -17.4/-8.1 mmHg), as well as nighttime ABP (-22.2/-13.3 versus -16.2/-7.4 mmHg), daytime ABP (-21.9/-13.0 versus -18.1/-8.6 mmHg), ABP in the last 4 hours of the dosing period (-21.5/-13.5 versus -17.0/-7.7 mmHg), and ABP load (21.7%/12.8% versus 30.8%/20.0%). CONCLUSION: Initiating antihypertensive treatment with moderate doses of ARB/CCB with a diuretic is more effective in lowering nighttime and daytime ABP and reducing ABP load than a maximal dose of an ARB with a diuretic. SN - 1178-2048 UR - https://www.unboundmedicine.com/medline/citation/22174580/Ambulatory_blood_pressure_response_to_triple_therapy_with_an_angiotensin_receptor_blocker__ARB__calcium_channel_blocker__CCB__and_HCTZ_versus_dual_therapy_with_an_ARB_and_HCTZ_ L2 - https://dx.doi.org/10.2147/VHRM.S25743 DB - PRIME DP - Unbound Medicine ER -