Korean Circ J.  2009 Apr;39(4):151-156. 10.4070/kcj.2009.39.4.151.

Losartan/Hydrochlorothiazide Fixed Combination Versus Amlodipine Monotherapy in Korean Patients With Mild to Moderate Hypertension

• Chung JW
• Lee HY
• Kim CH
• Seung IW
• Shin YW
• Jeong MH
• Cho MC
• Oh BH

• KMID: 2225690
• DOI: http://doi.org/10.4070/kcj.2009.39.4.151

Abstract

BACKGROUND AND OBJECTIVES
The antihypertensive efficacy and tolerability of losartan (LST) in fixed combination with hydrochlorothiazide (HCTZ) has not been compared to those of amlodipine monotherapy in Asians. This is an important comparison to draw, because Asians have been suggested to respond more favorably to calcium channel blockers and less favorably to angiotensin-converting enzyme inhibitors in comparison to Westerners. We sought to compare these two regimens in Korean patients with mild to moderate hypertension. SUBJECTS AND METHODS: 174 patients were randomized to receive LST 50 mg once daily, which could be titrated to LST/HCTZ 50/12.5 mg at 4 weeks, followed by 100/25 mg at 8 weeks; or to receive amlodipine besylate 2.5 mg once daily, which could be titrated to 5 mg at 4 weeks, followed by 10 mg at 8 weeks to achieve diastolic blood pressure <90 mmHg. RESULTS: At 12 weeks, the differences between the LST/HCTZ and amlodipine groups with regard to diastolic and systolic blood pressure were 1.2 mmHg (95% confidence interval: -1.1 to 3.4) and -0.5 mmHg (95% confidence interval: -4.3 to 3.4), respectively. The rates of achieving systolic blood pressure <140 mmHg were 66.7% in the LST/HCTZ group and 75.9% in the amlodipine group (p=0.20). The rates of drug-related adverse events were 15.6% in the LST/HCTZ group and 11.9% in the amlodipine group (p=0.49). CONCLUSION: The two regimens, with a relatively higher dose of LST/HCTZ compared to that required in Westerners, produced equivalent blood pressure reduction and were comparably well tolerated in Korean patients with mild to moderate hypertension.

Keyword

Drug combinations; Losartan; Hydrochlorothiazide; Amlodipine; Koreans

MeSH Terms

Amlodipine
Angiotensin-Converting Enzyme Inhibitors
Asian Continental Ancestry Group
Blood Pressure
Calcium Channel Blockers
Drug Combinations
Humans
Hydrochlorothiazide
Hypertension
Losartan
Amlodipine
Angiotensin-Converting Enzyme Inhibitors
Calcium Channel Blockers
Drug Combinations
Hydrochlorothiazide
Losartan

Figure

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  Fig. 1 The treatment schedules for the losartan/hydrochlorothiazide group and the amlodipine group. After a 2-week washout period, eligible patients were randomized to receive losartan 50 mg once daily or amlodipine besylate 2.5 mg once daily. Doses were titrated at 4 weeks and 8 weeks to achieve a diastolic blood pressure of <90 mmHg. WO: washout period, L: losartan, H: hydrochlorothiazide, A: amlodipine besylate.

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  Fig. 2 The proportion of patients treated with initial, once titrated, and fully titrated doses at 12 weeks in each group (sequentially from the bottom).

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  Fig. 3 Antihypertensive effects of the losartan-based regimen and the amlodipine-based regimen at 4, 8, and 12 weeks. The serial changes in sitting systolic and diastolic blood pressure during the active treatment period were no different between the two groups.

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