A Comparative Study of the Management of Stage 2 hypertension by Combined therapy with Losartan, Amlodipine and Hydrochlorothiazide.
BACKGROUND
The most effective and accurate treatment of hypertensive patients reduces cardiovascular events and improves the quality of life.


OBJECTIVE
This study compared the efficacy and safety of combined (combination therapy) with an angiotensin-receptor blocker (ARB) a calcium-channel blocker (CCB) (Losartan / Amloidipine 50/10mg) vs maximal combination doses of ARB with hydrochlorothiazide (Losartan /HCTZ 100/25 mg) and maximal combination doses of CCB with HCTZ (Amlodipine /HCTZ 10/25 mg) in the management of stage 2 hypertension.


METHODS
This randomized clinical trial (RTC) comprised 478 hypertensive patients with mean age 50.5±5.21 years, and took place between January 2010 and December 2011 in Vasei Hospital clinic in Sabzevar. Antihypertensive drugs were washed out after 5 days of discontinuation of drugs and the patients with mean blood pressure in sitting position ≥ 160 and <200 mmHg in systole and ≥ 100 and <110 mmHg in diastole were randomized into three groups: Losartan / Amlodipine 50/10 mg (n =164) , Losartan / HCTZ 100/25 mg (n =155) and Amlodipine / HCTZ 10/25 mg (n =159). The end point was reaching the blood pressure below 140/90 within 56 days of treatment in each group.


RESULTS
There was a significant difference in systolic blood pressure reductions between treatment groups (P<0.001) and also there was a significant difference between groups in reducing diastolic blood pressure (P<0.01). The highest systolic and diastolic blood pressure reduction respectively was found in Amlodipine/losartane and losartane/HTCZ group. The ANCOVA analysis revealed that only treatment regimen had a significant effect (P=0.01) and other factor including Age, Gender, Diabetes Mellitus, Smoking and High serum cholesterol didn't have significant effect on blood pressure reduction.


CONCLUSIONS
ARB/CCB combination therapy reduced blood pressure more effectively than the maximal doses of ARB or CCB with HCTZ in stage 2 hypertensive patients within this period of study.
Education Development Center, Sabzevar University of Medical Sciences, Sabzevar, IR Iran.
Reza
R
Jafarzadeh Esfehani
Mashhad University of medical science, Mashhad, IR Iran.
Azadeh
A
Mahmoodi Gharai
Mashhad University of medical science, Mashhad, IR Iran.
Ali
A
Jafarzadeh Esfehani
Education Development Center, Sabzevar University of Medical Sciences, Sabzevar, IR Iran.
Afsaneh
A
Rezaie Kalat
Education Development Center, Sabzevar University of Medical Sciences, Sabzevar, IR Iran.
Faezeh
F
Abbasi
Cardiology Department, Sabzevar University of Medical Sciences, Sabzevar, IR Iran.
Majid
M
Jalalyazdi
Angiotensin Receptor Blocker; Calcium Channel Blocker; Hypertension