title: Comparison of the effects of amlodipine and losartan on blood pressure and diurnal variation in hypertensive stroke patients: a prospective, randomized, double-blind, comparative parallel study.
abstract: BACKGROUND
  Lowering blood pressure (BP) and reducing diurnal variation are important for the prevention of stroke in patients with hypertension.
  
  
  OBJECTIVE
  This study was conducted to compare the BP-lowering and diurnal BP variation effects of amlodipine and losartan on acute stroke patients.
  
  
  METHODS
  Seventy-seven hypertensive patients with acute stroke were enrolled in this randomized, double-blind, single-center clinical trial. They were randomly assigned to receive either amlodipine or losartan daily. To evaluate whether amlodipine was noninferior to losartan, ambulatory BP monitoring was performed before the drugs were first administered and at the end of week 8. BP variables analyzed included the mean awake, sleep, morning, evening, and prewake BP values; the nocturnal dipping status; and the morning surge.
  
  
  RESULTS
  Thirty-nine patients in the amlodipine group and 38 patients in the losartan group completed the follow-up. In the baseline characteristics, mean age was 63.6 years, and 68.8% were male. In the intention-to-treat analysis, the mean (SD) systolic BP decreased 14.82 (11.71) mm Hg in the amlodipine group and 13.11 (12.69) mm Hg in the losartan group, and amlodipine proved noninferior to losartan (mean difference, 1.71 mm Hg [95% CI, -3.83 to 7.26]). However, in the per-protocol analysis, noninferiority was not proven (BP reduction, 16.06 [11.33] vs 17.17 [11.85] mm Hg; mean difference, -1.11 mm Hg [95% CI, -6.88 to 4.65]). Amlodipine had a greater tendency than losartan to produce a blunt morning surge.
  
  
  CONCLUSIONS
  The noninferiority of amlodipine was not confirmed by the per-protocol analysis. However, amlodipine showed a favorable effect on the morning surge. ClinicalTrials.gov identifier: NCT01830517.
authors.affiliation: Department of Neurology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Hyung-Min
authors.initials: HM
authors.lastname: Kwon
authors.affiliation: Department of Neurology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Jung-Won
authors.initials: JW
authors.lastname: Shin
authors.affiliation: Department of Neurology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Jae-Sung
authors.initials: JS
authors.lastname: Lim
authors.affiliation: Department of Neurology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Yoon-Ho
authors.initials: YH
authors.lastname: Hong
authors.affiliation: Department of Neurology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Yong-Seok
authors.initials: YS
authors.lastname: Lee
authors.affiliation: Department of Neurology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea. Electronic address: hwnam@brm.co.kr.
authors.forename: Hyunwoo
authors.initials: H
authors.lastname: Nam
mesh_terms: D000368:Aged; D017311:Amlodipine / Q000009:adverse effects / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm / Q000187:drug effects; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D019808:Losartan / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020521:Stroke / Q000150:complications / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D017311:Amlodipine; D019808:Losartan
keywords: amlodipine; blood pressure; losartan; stroke