Results of increasing doses of hydrochlorothiazide in combination with an angiotensin receptor blocker in patients with uncontrolled hypertension.
This study examined the effects of increasing the thiazide diuretic dose in a fixed-dose ARB/diuretic combination in patients with uncontrolled hypertension despite 6 weeks' open-label treatment with the ARB/diuretic combination, telmisartan 80 mg/hydrochlorothiazide 12.5 mg (T80/H12.5). 713 patients with trough seated DBP =90 mmHg were then randomized to 8 weeks' double-blind treatment with telmisartan 80 mg and an increased dose of 25 mg of hydrochlorothiazide (T80/H25) or T80/H12.5. Adjusted mean seated DBP changes from baselines of 95.3 (T80/H25) and 95.0 mmHg (T80/H12.5) were -7.1 and --5.5 mmHg (difference: 1.6 mm Hg), respectively (P=.0012). Changes in systolic blood pressure from 147.9 mmHg (T80/H25) and 147.4 mmHg (T80/H12.5) were -9.8 and -7.1 mmHg (difference: 2.7 mm Hg) (P=.0003). Adverse events occurred in 31.5% (T80/H25) and 29.6% (T80/H12.5), with serious events in 1.4% and 0.8%, respectively. Hypokalemia was rare. These results show that higher-dose thiazide diuretic in combination with T80 in patients with hypertension uncontrolled by T80/H12.5 provides additional blood pressure reductions and is well tolerated.
Neldam
Steen
S
Rødovre Centrum, Denmark. neldam@dadlnet.dk
Edwards
Colin
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage*; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001562:Benzimidazoles / Q000008:administration & dosage*; D001565:Benzoates / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000008:administration & dosage*; D006973:Hypertension / Q000188:drug therapy* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D000077333:Telmisartan; D016896:Treatment Outcome
D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents; D001562:Benzimidazoles; D001565:Benzoates; D006852:Hydrochlorothiazide; D000077333:Telmisartan
Arch Intern Med. 2007 Jan 22;167(2):141-7
17242314
J Clin Hypertens (Greenwich). 2003 Jan-Feb;5(1):58-63
12556655
J Hypertens. 2007 Jul;25(7):1491-8
17563573
J Clin Hypertens (Greenwich). 2006 Sep;8(9):626-33
16957424
Hypertens Res. 2005 Jul;28(7):555-63
16335883
J Hypertens. 2006 Jun;24(6):1193-200
16685222
Circulation. 2005 Feb 8;111(5):697-716
15699287
Scand J Prim Health Care. 2006 Dec;24(4):224-30
17118862
J Hypertens. 2006 Jun;24(6):1187-92
16685220
Am J Ther. 2007 Mar-Apr;14(2):154-60
17414583
Hypertension. 2007 Jan;49(1):69-75
17159087
J Hypertens. 2003 Nov;21(11):1983-92
14597836
J Clin Hypertens (Greenwich). 2007 May;9(5):316-23
17485966
J Hypertens. 2007 Jun;25(6):1105-87
17563527
Diabetes Care. 2004 Jan;27 Suppl 1:S65-7
14693929
J Int Med Res. 2000 Jul-Aug;28(4):149-67
11014323
J Hum Hypertens. 2007 Feb;21(2):99-106
17136106
Am J Hypertens. 1992 Apr;5(4 Pt 1):207-9
1599634
Expert Opin Pharmacother. 2004 Nov;5(11):2303-10
15500377
Hypertension. 2003 Dec;42(6):1206-52
14656957
Lancet. 2002 Dec 14;360(9349):1903-13
12493255
Drugs. 2006;66(1):51-83
16398568
J Hum Hypertens. 2006 Nov;20(11):841-9
16915300
Am J Med. 2007 Aug;120(8):713-9
17679131
Ann Intern Med. 2003 Jul 15;139(2):137-47
12859163
Clin Ther. 2005 Nov;27(11):1795-805
16368450
Clin Ther. 2001 Jun;23(6):833-50
11440284