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Comparison of medium-dose losartan/hydrochlorothiazide and maximal-dose angiotensin II receptor blockers in the treatment of Japanese patients with uncontrolled hypertension: the Kobe-CONNECT Study.
Hypertens Res. 2012 Nov; 35(11):1080-6.HR

Abstract

The objective of this study is to examine the effects of thiazide diuretics, plus medium-dose losartan versus maximal-dose angiotensin II receptor blockers (ARBs) on blood pressure (BP) in Japanese patients with uncontrolled hypertension despite the use of medium-dose ARBs. Hypertensive patients in whom BP was inadequately controlled by treatment with medium-dose ARBs alone or with calcium-channel blockers were enrolled. Patients were randomly assigned to a fixed-dose combination of 50 mg per day losartan and 12.5 mg per day hydrochlorothiazide (HCTZ; n=98), or to a maximal dose of current ARBs (n=95). The reduction in office BP from baseline was significantly larger in the losartan/HCTZ group than in the maximal-dose ARB group (systolic BP -22.7±13.7 vs. -11.7±13.0 mm Hg, diastolic BP -9.6±10.9 vs. -4.5±11.0 mm Hg; P<0.01, respectively). The proportion of patients in whom the therapeutic target BP was achieved was greater in the losartan/HCTZ group than in the maximal-dose ARB group (59.2 vs. 26.3%; P<0.001). Both early-morning and evening BP were controlled more effectively over 1 year of treatment in the losartan/HCTZ group than in the maximal-dose ARB group (the mean BP difference between the groups, early-morning: 5.6 mm Hg (P=0.001), evening: 3.8 mm Hg (P=0.049)). Adverse changes in serum potassium and uric acid were observed in the losartan/HCTZ group; however, both changes were very slight, and the values were still within the normal range. The concomitant usage of losartan and HCTZ had no influence on glucose metabolism and lipid profiles. Declines in plasma N-terminal pro-brain natriuretic peptide levels and urinary albumin excretion were observed in the losartan/HCTZ group, but not in the maximal-dose ARB group. Switching from medium-dose ARBs to losartan plus HCTZ reduced both office and home BP efficiently in patients with uncontrolled hypertension.

Authors+Show Affiliations

Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan. rtoh@med.kobe-u.ac.jpNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo 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

22786569

Citation

Toh, Ryuji, et al. "Comparison of Medium-dose Losartan/hydrochlorothiazide and Maximal-dose Angiotensin II Receptor Blockers in the Treatment of Japanese Patients With Uncontrolled Hypertension: the Kobe-CONNECT Study." Hypertension Research : Official Journal of the Japanese Society of Hypertension, vol. 35, no. 11, 2012, pp. 1080-6.
Toh R, Ishida T, Nishimura K, et al. Comparison of medium-dose losartan/hydrochlorothiazide and maximal-dose angiotensin II receptor blockers in the treatment of Japanese patients with uncontrolled hypertension: the Kobe-CONNECT Study. Hypertens Res. 2012;35(11):1080-6.
Toh, R., Ishida, T., Nishimura, K., Nonaka, H., Inoue, Y., Kitagawa, Y., Suematsu, M., Miki, T., Emoto, N., & Hirata, K. (2012). Comparison of medium-dose losartan/hydrochlorothiazide and maximal-dose angiotensin II receptor blockers in the treatment of Japanese patients with uncontrolled hypertension: the Kobe-CONNECT Study. Hypertension Research : Official Journal of the Japanese Society of Hypertension, 35(11), 1080-6. https://doi.org/10.1038/hr.2012.110
Toh R, et al. Comparison of Medium-dose Losartan/hydrochlorothiazide and Maximal-dose Angiotensin II Receptor Blockers in the Treatment of Japanese Patients With Uncontrolled Hypertension: the Kobe-CONNECT Study. Hypertens Res. 2012;35(11):1080-6. PubMed PMID: 22786569.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of medium-dose losartan/hydrochlorothiazide and maximal-dose angiotensin II receptor blockers in the treatment of Japanese patients with uncontrolled hypertension: the Kobe-CONNECT Study. AU - Toh,Ryuji, AU - Ishida,Tatsuro, AU - Nishimura,Kunihiro, AU - Nonaka,Hidemi, AU - Inoue,Yoshimichi, AU - Kitagawa,Yasuo, AU - Suematsu,Masakuni, AU - Miki,Takashi, AU - Emoto,Noriaki, AU - Hirata,Ken-Ichi, Y1 - 2012/07/12/ PY - 2012/7/13/entrez PY - 2012/7/13/pubmed PY - 2013/9/7/medline SP - 1080 EP - 6 JF - Hypertension research : official journal of the Japanese Society of Hypertension JO - Hypertens. Res. VL - 35 IS - 11 N2 - The objective of this study is to examine the effects of thiazide diuretics, plus medium-dose losartan versus maximal-dose angiotensin II receptor blockers (ARBs) on blood pressure (BP) in Japanese patients with uncontrolled hypertension despite the use of medium-dose ARBs. Hypertensive patients in whom BP was inadequately controlled by treatment with medium-dose ARBs alone or with calcium-channel blockers were enrolled. Patients were randomly assigned to a fixed-dose combination of 50 mg per day losartan and 12.5 mg per day hydrochlorothiazide (HCTZ; n=98), or to a maximal dose of current ARBs (n=95). The reduction in office BP from baseline was significantly larger in the losartan/HCTZ group than in the maximal-dose ARB group (systolic BP -22.7±13.7 vs. -11.7±13.0 mm Hg, diastolic BP -9.6±10.9 vs. -4.5±11.0 mm Hg; P<0.01, respectively). The proportion of patients in whom the therapeutic target BP was achieved was greater in the losartan/HCTZ group than in the maximal-dose ARB group (59.2 vs. 26.3%; P<0.001). Both early-morning and evening BP were controlled more effectively over 1 year of treatment in the losartan/HCTZ group than in the maximal-dose ARB group (the mean BP difference between the groups, early-morning: 5.6 mm Hg (P=0.001), evening: 3.8 mm Hg (P=0.049)). Adverse changes in serum potassium and uric acid were observed in the losartan/HCTZ group; however, both changes were very slight, and the values were still within the normal range. The concomitant usage of losartan and HCTZ had no influence on glucose metabolism and lipid profiles. Declines in plasma N-terminal pro-brain natriuretic peptide levels and urinary albumin excretion were observed in the losartan/HCTZ group, but not in the maximal-dose ARB group. Switching from medium-dose ARBs to losartan plus HCTZ reduced both office and home BP efficiently in patients with uncontrolled hypertension. SN - 1348-4214 UR - https://www.unboundmedicine.com/medline/citation/22786569/Comparison_of_medium_dose_losartan/hydrochlorothiazide_and_maximal_dose_angiotensin_II_receptor_blockers_in_the_treatment_of_Japanese_patients_with_uncontrolled_hypertension:_the_Kobe_CONNECT_Study_ L2 - http://dx.doi.org/10.1038/hr.2012.110 DB - PRIME DP - Unbound Medicine ER -