title: Switching therapy from variable-dose multiple pill to fixed-dose single-pill combinations of angiotensin II receptor blockers and thiazides for hypertension.
abstract: The efficacy and tolerability of switching therapy from free combinations of angiotensin II receptor blocker (ARB) and thiazide (A/T) to a fixed-dose of losartan and hydrochlorothiazide (L/H) has not been evaluated in Japan. We examined effects of switching therapy from variable-dose multiple-pill A/T to a fixed-dose L/H on blood pressure (BP) along with medication adherence and the degree of satisfaction in 91 hypertensive outpatients (mean age, 65.2 ± 9.6 years). After 6 months, a significant BP reduction (132 ± 9/76 ± 10 vs. 126 ± 12/72 ± 11 mm Hg), along with an improvement of attaining target BP (44.0 vs. 61.5%) and that of adherence, were observed. The magnitude of BP reduction in the participants increased their degree of satisfaction more significantly than in the participants who worsened their degree of satisfaction. The estimated glomerular filtration rate and the serum uric acid (UA) level decreased slightly but significantly. The hemoglobin A1c of participants with diabetes mellitus increased slightly but significantly. In conclusion, a switch in therapy from variable-dose, multiple-pill A/T combinations to a fixed-dose, single-pill L/H was effective in decreasing BP and serum UA in Japanese clinical practice. Metabolic side effects of L/H in patients with diabetes mellitus remain to be investigated.
authors.affiliation: Department of Cardiovascular Medicine, Nephrology, and Neurology, University of the Ryukyus School of Medicine, Nishihara-cho, Okinawa, Japan. asakima@med.u-ryukyu.ac.jp
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sakima
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Ohshiro
authors.forename: Seigo
authors.initials: S
authors.lastname: Nakada
authors.forename: Masanobu
authors.initials: M
authors.lastname: Yamazato
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kohagura
authors.forename: Minori
authors.initials: M
authors.lastname: Nakamoto
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tana
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Ohya
mesh_terms: D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage*; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D004338:Drug Combinations; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000008:administration & dosage; D006973:Hypertension / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D007564:Japan; D019808:Losartan / Q000008:administration & dosage; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D017060:Patient Satisfaction; D049993:Sodium Chloride Symporter Inhibitors / Q000008:administration & dosage*
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents; D004338:Drug Combinations; D049993:Sodium Chloride Symporter Inhibitors; D006852:Hydrochlorothiazide; D019808:Losartan