Effectiveness of chlorthalidone/amiloride versus losartan in patients with stage I hypertension: results from the PREVER-treatment randomized trial.
| Autor: | Fuchs FD; aHospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rio Grande do SulbHospital Universitário Júlio Müller - Universidade Federal de Mato Grosso, Mato GrossocFaculdade de Medicina São José do Rio Preto, São PaulodDepartment of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USAeFaculdade de Medicina Hospital São Lucas, PUCRSfHospital Universitário Walter Cantídio, Universidade Federal do CearágInstituto do Coração, Faculdade de Medicina, Universidade de São PaulohFaculdade de Ciências Farmacêuticas, USP Ribeirão Preto, São PauloiInstituto de Cardiologia, Rio Grande do SuljHospital Universitário, Universidade Federal do Maranhão, MaranhãokUniversidade Federal de Pernambuco, PernambucolUniversidade Federal de Pelotas, Rio Grande do SulmInstituto de Medicina Integral Prof Fernando Figueira, PernambuconUniversidade do Estado do Rio de Janeiro, Rio de JaneirooHospital das Clínicas da Universidade Federal de Minas Gerais, Minas GeraispHospital das Clínicas de Goiânia, Universidade Federal de Goiás, GoiásqFaculdade de Medicina de Botucatu, São PaulorHospital do Coração, AlagoassAnis Rassi Hospital, GoiástHospital Universitário Procape, PernambucouHospital Universitário Antônio Pedro, UFF, Rio de JaneirovFaculdade de Medicina de Ribeirão Preto, USP Ribeirão PretowInstituto de Pesquisa, Hospital do Coração, São Paulo, Brazil., Scala LC, Vilela-Martin JF, de Mello RB, Mosele F, Whelton PK, Poli-de-Figueiredo CE, de Alencastro PR, E Silva RP, Gus M, Bortolotto LA, Schlatter R, Cesarino EJ, Castro I, Neto JA, Chaves H, Steffens AA, Alves JG, Brandão AA, de Sousa MR, Jardim PC, Moreira LB, Franco RS, Gomes MM, Neto AA, Fuchs FC, Filho DC, Nóbrega AC, Nobre F, Berwanger O, Fuchs SC |
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| Jazyk: | angličtina |
| Zdroj: | Journal of hypertension [J Hypertens] 2016 Apr; Vol. 34 (4), pp. 798-806. |
| DOI: | 10.1097/HJH.0000000000000837 |
| Abstrakt: | Objectives: To compare the blood pressure (BP)-lowering efficacy of a chlorthalidone/amiloride combination pill with losartan, during initial management of stage I hypertension. Methods: In a randomized, double-blind, controlled trial, 655 participants were followed for 18 months in 21 Brazilian academic centers. Trial participants were adult volunteers aged 30-70 years with stage I hypertension (BP 140-159 or 90-99 mmHg) following 3 months of a lifestyle intervention. Participants were randomized to 12.5/2.5 mg of chlorthalidone/amiloride (N = 333) or 50 mg of losartan (N = 322). If BP remained uncontrolled after 3 months, study medication dose was doubled, and if uncontrolled after 6 months, amlodipine (5 and 10 mg) and propranolol (40 and 80 mg twice daily) were added as open-label drugs in a progressive fashion. At the end of follow-up, 609 (93%) participants were evaluated. Results: The difference in SBP during 18 months of follow-up was 2.3 (95% confidence interval: 1.2 to 3.3) mmHg favoring chlorthalidone/amiloride. Compared with those randomized to diuretic, more participants allocated to losartan had their initial dose doubled and more of them used add-on antihypertensive medication. Levels of blood glucose, glycosilated hemoglobin, and incidence of diabetes were no different between the two treatment groups. Serum potassium was lower and serum cholesterol was higher in the diuretic arm. Microalbuminuria tended to be higher in patients with diabetes allocated to losartan (28.5 ± 40.4 versus 16.2 ± 26.7 mg, P = 0.09). Conclusion: Treatment with a combination of chlorthalidone and amiloride compared with losartan yielded a greater reduction in BP. Clinical Trials Registration Number: NCT00971165. |
| Databáze: | MEDLINE |
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