title: Achieving blood pressure goal: initial therapy with valsartan/hydrochlorothiazide combination compared with monotherapy.
abstract: The benefits of valsartan (Val)/hydrochlorothiazide (HCTZ) combination as initial treatment for hypertension were evaluated in a post hoc analysis of an 8-week, double-blind, placebo-controlled, parallel-group trial. The highest dose of Val/HCTZ combination (320/25 mg), component monotherapies (Val 320 mg, HCTZ 25 mg) and placebo were selected for this analysis (N=675, 52.1% men, 68.6% Caucasians, mean age 52.9 years, baseline blood pressure (BP) 150.6/99.1 mm Hg). As soon as 2 weeks after initiation of active therapy, greater BP control rates were observed with Val/HCTZ (320/25 mg) compared with Val (320 mg), HCTZ (25 mg) and placebo. Similar results were observed in subgroups of patients with stage 1 and stage 2 hypertension, as well as in diabetic patients. As baseline BP increased, the probability of achieving mean sitting systolic BP (<140 and <130 mm Hg) and mean sitting diastolic BP control (<90 and <80 mm Hg), determined using a logistic regression model, decreased with all treatments. However, at all levels of baseline BP, the probability of achieving BP control was greater with Val/HCTZ combination. The Val/HCTZ combination was well tolerated with overall incidence of adverse events similar to that observed with monotherapy and placebo. These results support the use of Val/HCTZ combination as initial therapy in hypertensive patients unlikely to achieve BP control with a single agent.
authors.affiliation: Department of Medicine, Hypertension Research Center, Indiana University School of Medicine, Indianapolis, IN 46202, USA. mweinbe@iupui.edu
authors.forename: M H
authors.initials: MH
authors.lastname: Weinberger
authors.forename: R D
authors.initials: RD
authors.lastname: Glazer
authors.forename: N A
authors.initials: NA
authors.lastname: Crikelair
authors.forename: Y T
authors.initials: YT
authors.lastname: Chiang
mesh_terms: D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D004232:Diuretics / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D004338:Drug Combinations; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000009:adverse effects / Q000627:therapeutic use*; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015990:Placebo Effect; D013777:Tetrazoles / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D014633:Valine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000068756:Valsartan
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents; D004232:Diuretics; D004338:Drug Combinations; D013777:Tetrazoles; D006852:Hydrochlorothiazide; D000068756:Valsartan; D014633:Valine