| Autor: |
MacDonald, TM, Williams, B, Webb, DJ, Morant, S, Caulfield, M, Cruickshank, JK, Ford, I, Sever, P, Mackenzie, IS, Padmanabhan, S, McCann, GP, Salsbury, J, McInnes, G, Brown, MJ, Schumann, A, Helmy, J, Maniero, C, Burton, TJ, Quinn, U, Hobbs, L, Palmer, J, Collier, D, Markandu, N, Saxena, M, Zak, A, Enobakhare, E, Mackay, J, Thom, SA, Coughlan, C, McGinnis, AR, Findlay, E, Stanley, AG, White, C, Lacy, P, Gardiner-Hill, CJ, Nazir, S, McInnes, GT, Muir, S, McCallum, L, Melville, V, MacIntyre, IM, Brown, R, Simon, R, Soran, H, Kwok, S, Balakrishnan, K, Hobbs, R, Iles, R, Myint, KS, Cannon, J, Hood, S, Rutkowski, K, Webb, A, Martin, U, Kean, S, Wilson, R, Papworth, R |
| Rok vydání: |
2017 |
| Zdroj: |
Journal of the American Heart Association. 6(11) |
| ISSN: |
2047-9980 |
| Popis: |
Background--Guidelines for hypertension vary in their preference for initial combination therapy or initial monotherapy, stratified by patient profile; therefore, we compared the efficacy and tolerability of these approaches. Methods and Results--We performed a 1-year, double-blind, randomized controlled trial in 605 untreated patients aged 18 to 79 years with systolic blood pressure (BP) ≥150 mm Hg or diastolic BP ≥95 mm Hg. In phase 1 (weeks 0-16), patients were randomly assigned to initial monotherapy (losartan 50-100 mg or hydrochlorothiazide 12.5-25 mg crossing over at 8 weeks), or initial combination (losartan 50-100 mg plus hydrochlorothiazide 12.5-25 mg). In phase 2 (weeks 17-32), all patients received losartan 100 mg and hydrochlorothiazide 12.5 to 25 mg. In phase 3 (weeks 33-52), amlodipine with or without doxazosin could be added to achieve target BP. Hierarchical primary outcomes were the difference from baseline in home systolic BP, averaged over phases 1 and 2 and, if significant, at 32 weeks. Secondary outcomes included adverse events, and difference in home systolic BP responses between tertiles of plasma renin. Home systolic BP after initial monotherapy fell 4.9 mm Hg (range: 3.7-6.0 mm Hg) less over 32 weeks (P < 0.001) than after initial combination but caught up at 32 weeks (difference 1.2 mm Hg [range: -0.4 to 2.8 mm Hg], P=0.13). In phase 1, home systolic BP response to each monotherapy differed substantially between renin tertiles, whereas response to combination therapy was uniform and at least 5 mm Hg more than to monotherapy. There were no differences in withdrawals due to adverse events. Conclusions--Initial combination therapy can be recommended for patients with BP > 150/95 mm Hg. |
| Databáze: |
OpenAIRE |
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