ANGIOTENSIN II RECEPTOR BLOCKER COMBINED WITH CALCIUM CHANNEL BLOCKER IS MORE EFFECTIVE IN REDUCTION OF BLOOD PRESSURE VARIABILITY THAN COMBINED WITH DIURETICS

Abstract

Objective: Hypertensive patients with greater blood pressure variability (BPV) are associated with a higher rate of cardiovascular events. We compared the efficacy of angiotensin II receptor blocker (ARB)/calcium-channel blocker combination with ARB/diuretic combination in reduction of 24-hour BPV.

Design and Method: In a prospective, randomized, double-blind trial, hypertensive patients were assigned to Losartan/Amlodipine (L/A, dose of 50 mg/5 mg or 100 mg/5 mg) group or Losartan/Hydrochlorothiazide (L/H, dose of 50 mg/12.5 mg or 100 mg/25 mg) group. 24-hour ambulatory BP was measured at baseline and after 20 weeks treatment. BPV was calculated from weighted standard deviation and compared between two groups.

Results: Total 220 patients [mean age = 59.6 ± 12.3 years, men = 154 (70%)] were enrolled. After 20 weeks treatment, systolic and diastolic weighted standard deviations were significantly lower in L/A group than L/H group. (Table) In multivariate regression analysis, significant difference of diastolic weighted standard deviation after 20 weeks treatment was independent of 24-hour SBP and DBP between two groups.

Conclusions: ARB/calcium-channel blocker combination is more favorable in reduction of 24-hour BPV than ARB/diuretic combination independent of 24-hour BP differences.