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Differential effects of strict blood pressure lowering by losartan/hydrochlorothiazide combination therapy and high-dose amlodipine monotherapy on microalbuminuria: the ALPHABET study
Journal of the American Society of Hypertension, 01/18/2012
Clinical Article
Fukutomi M et al. – Losartan/HCTZ combination and high–dose amlodipine have similar effects on clinic, home, and ambulatory BP control and BNP reduction, whereas losartan/HCTZ has superior effect on UACR reduction when compared with high–dose amlodipine.
Methods- In this open–label multicenter trial, hypertensive patients were randomly allocated to receive losartan 50 mg or amlodipine 5 mg for 4 weeks, and the treatments were changed to combination of losartan 50 mg/HCTZ 12.5 mg or amlodipine 10 mg for a further 4 weeks.
- A total of 91 hypertensive patients (age 63.6 years), 47 in the losartan/HCTZ group and 44 in amlodipine group, were enrolled.
- After 8 weeks, the clinic BP, home BP, and 24–hour ambulatory BP were successfully controlled to the same level in both treatment groups (P < .001).
- Furthermore, both groups showed the same degree of BP reduction in the 24–hour, daytime, and nighttime (P < .001).
- B–type natriuretic peptide (BNP) also significantly decreased to the same level in both groups, whereas the reduction of urinary albumin/creatinine ratio (UACR) was greater in the losartan/HCTZ group than in the high–dose amlodipine group (–47.6% vs 2.4%, P < .001).