title: [Efficacy and safety of combination therapy with losartan and hydrochlorothiazide in elderly hypertension].
abstract: We examined the effect and safety of combination therapy with low-dose diuretics (hydrochlorothiazide: HCTZ) and angiotensin II receptor antagonist (losartan) in elderly cases of hypertension, using ambulatory blood pressure monitoring (ABPM). Elderly hypertensive patients (mean age 75 +/- 2 years) were treated with either losartan (25-50 mg/day) or HCTZ (12.5 mg/day) for at least 4 weeks, and then 24-hour blood pressure (BP) was measured by ABPM. Combination therapy with addition of other drug was initiated in 14 patients whose 24-hour systolic BP or daytime systolic BP was over 140 mmHg (160 mmHg for the patients of 80 years or older). After 4 weeks of the combination therapy, ABPM was repeated. Blood cell count and blood chemistry were also done before and after initiation of combination therapy. In the losartan-preceding group (n = 9), the combination therapy with HCTZ reduced 24-hour BP by 19.3 +/- 2.3/6.6 +/- 2.3 mmHg. Similarly, daytime and nighttime BP decreased by 21.4 +/- 4/8.4 +/- 2.8 mmHg and 15.2 +/- 4/4.2 +/- 2.4 mmHg, respectively. In the HCTZ-preceding group, the combination with losartan also decreased 24-hour BP by 12.2 +/- 4.8/3.4 +/- 1.4 mmHg. The decreases of daytime and nighttime BP were 13.8 +/- 6.6/4 +/- 1.1 mmHg and 10 +/- 4.7/3 +/- 2.4 mmHg, respectively. Heart rate did not change with combination therapy in the losartan-preceding group, while heart rate during daytime tended to decrease by addition of losartan in the HCTZ-preceding group (3.8 +/- 1.7/min). Serum electrolytes, uric acid, lipids, renal function and body weight did not change during the study period. Thus, combination therapy of losartan/hydrochlorothiazide seems useful in the treatment of elderly hypertension, showing additive BP lowering effect without metabolic adverse effects.
authors.affiliation: Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University.
authors.forename: Kimika
authors.initials: K
authors.lastname: Eto
authors.forename: Takuya
authors.initials: T
authors.lastname: Tsuchihashi
authors.forename: Isao
authors.initials: I
authors.lastname: Abe
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Iida
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004232:Diuretics; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000008:administration & dosage / Q000627:therapeutic use*; D006973:Hypertension / Q000188:drug therapy*; D019808:Losartan / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D049993:Sodium Chloride Symporter Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000959:Antihypertensive Agents; D004232:Diuretics; D049993:Sodium Chloride Symporter Inhibitors; D006852:Hydrochlorothiazide; D019808:Losartan