title: Effectiveness of open-label losartan/hydrochlorothiazide combination therapy in Asian patients with hypertension not controlled with ACE inhibitor or ARB monotherapy.
abstract: Antihypertensive efficacy and safety of losartan/hydrochlorothiazide (HCTZ) combinations have not been adequately studied in Asians. In this open-label, 12-week study in seven Asian areas, patients on monotherapy with angiotensin receptor blockers (ARBs) or angiotensin-converting enzyme inhibitors (ACEIs) but not at blood pressure (BP) goal (sitting diastolic BP (SiDBP) <90 mm Hg in non-diabetics and <80 mm Hg in diabetics) were switched to losartan 50 mg/HCTZ 12.5 mg. At 4 and 8 weeks, the therapy for patients not at goal BP was titrated to losartan 100 mg/HCTZ 12.5 mg and to losartan 100 mg/HCTZ 25 mg, respectively. Data analysis included 430 patients with mean (s.d.) age 53.0 (10.1) years and 51.9% of the female gender. After 8 weeks (primary end point; titration up to losartan 100 mg/HCTZ 12.5 mg), 73.5% (95% confidence interval (CI): 69.0-77.6) of patients reached BP goal; 63.4 and 78.1% of patients reached BP goal at 4 weeks (titration up to losartan 50 mg/HCTZ 12.5 mg) and at 12 weeks (titration up to losartan 100 mg/HCTZ 25 mg). The mean changes from baseline (95% CI) in sitting systolic BP and SiDBP at 8 weeks were -16.7 (-18.0 to -15.4) mm Hg and -12.1 (-12.9 to -11.4) mm Hg, respectively. Clinical and laboratory adverse experiences (AEs) were reported in 27.5 and 21.0% of patients, respectively. Nine patients were discontinued because of drug-related clinical AEs. Switching Asian patients currently not at BP goal with ARB or ACEI monotherapy to a losartan/HCTZ combination achieved BP goal in the majority of patients. Losartan/HCTZ combinations were generally well tolerated.
authors.affiliation: Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Republic of Korea. kks7379@cu.ac.kr
authors.forename: Kee-Sik
authors.initials: KS
authors.lastname: Kim
authors.forename: Wei Hu
authors.initials: WH
authors.lastname: Fan
authors.forename: Young-Dae
authors.initials: YD
authors.lastname: Kim
authors.forename: Wenling
authors.initials: W
authors.lastname: Zhu
authors.forename: Yen Yew
authors.initials: YY
authors.lastname: Ngau
authors.forename: Peter
authors.initials: P
authors.lastname: Tong
authors.forename: Byung-Soo
authors.initials: BS
authors.lastname: Kim
authors.forename: Maureen
authors.initials: M
authors.lastname: Santos
authors.forename: Wei-Hsiang
authors.initials: WH
authors.lastname: Lin
authors.forename: Peera
authors.initials: P
authors.lastname: Buranakitjaroen
authors.forename: Rachid
authors.initials: R
authors.lastname: Massaad
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D044466:Asian People; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D004232:Diuretics / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000009:adverse effects / Q000627:therapeutic use*; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D019808:Losartan / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000517:prevention & control; D055815:Young Adult
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics; D006852:Hydrochlorothiazide; D019808:Losartan