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Thiazide Diuretic-Induced Change in Fasting Plasma Glucose: a Meta-analysis of Randomized Clinical Trials. J Gen Intern Med 2020; 35:1849-1860. [PMID: 32157653 PMCID: PMC7280437 DOI: 10.1007/s11606-020-05731-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 02/10/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Prior meta-analyses measuring thiazide-induced glycemic change have demonstrated an increased risk of incident diabetes; however, this measure's definition has changed over time. AIM To determine the magnitude of change in fasting plasma glucose (FPG) for thiazide diuretics. DATA SOURCES A research librarian designed and conducted searches in Medline®, EMBASE, and EBM Reviews-Cochrane Central Register of Controlled Trials (inception through July 2018) and International Pharmaceutical Abstracts (inception to December 2014). STUDY SELECTION Randomized, controlled trials comparing a thiazide or thiazide-like diuretic to any comparator reporting FPG were identified. Trials enrolling < 50 participants, those with a follow-up period of < 4 weeks, and conference abstracts were excluded. DATA EXTRACTION Independent duplicate screening of citations and full-text articles, data extraction, and assessment of risk of bias was conducted. DATA SYNTHESIS Ninety-five studies were included (N = 76,608 participants), with thiazides compared with placebo, beta-blockers, calcium channel blockers, renin-angiotensin-aldosterone-system inhibitors, potassium-sparing diuretic, and others alone or in combination. Thiazide diuretics marginally increased FPG (weighted mean difference 0.20 mmol/L (95% CI 0.15-0.25); I2 = 84%) (1 mmol/L = 18 mg/dL). Results did not change substantially when considering dose or duration, comparing thiazides with placebo or an active comparator, or using thiazides as monotherapy or combination therapy, even when combined with a potassium-correcting agent. CONCLUSION Thiazide diuretics have a small and clinically unimportant impact on FPG.
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Hosaka M, Inoue R, Satoh M, Watabe D, Hanazawa T, Ohkubo T, Asayama K, Obara T, Imai Y. Effect of amlodipine, efonidipine, and trichlormethiazide on home blood pressure and upper-normal microalbuminuria assessed by casual spot urine test in essential hypertensive patients. Clin Exp Hypertens 2017; 40:468-475. [PMID: 29172732 DOI: 10.1080/10641963.2017.1403617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The aim of this study was to assess the effects of irbesartan alone and combined with amlodipine, efonidipine, or trichlormethiazide on blood pressure (BP) and urinary albumin (UA) excretion in hypertensive patients with microalbuminuria (30≤UA/creatinine (Cr) ratio [UACR] <300 mg/g Cr) and upper-normal microalbuminuria (10≤UACR<30 mg/g Cr). This randomized controlled trial enrolled 175 newly diagnosed and untreated hypertensive patients (home systolic blood pressure [SBP]≥135 mmHg; 10≤UACR<300 mg/g Cr of casual spot urine at the first visit to clinic). All patients were treated with irbesartan (week 0). Patients who failed to achieve home SBP ≤125 mmHg on 8-week irbesartan monotherapy (nonresponders, n = 115) were randomized into three additional drug treatment groups: trichlormethiazide (n = 42), efonidipine (n = 39), or amlodipine (n = 34). Irbesartan monotherapy decreased home SBP and first morning urine samples (morning UACR) for 8 weeks (p < 0.0001). At 8 weeks after randomization, all three additional drugs decreased home SBP (p < 0.0002) and trichlormethiazide significantly decreased morning UACR (p = 0.03). Amlodipine decreased morning UACR in patients with microalbuminuria based on casual spot urine samples (p = 0.048). However, multivariate analysis showed that only higher home SBP and UACR at week 8, but not any additional treatments, were significantly associated with UACR reduction between week 8 and week 16. In conclusion, crucial points of the effects of combination therapy on UACR were basal UACR and SBP levels. The effect of trichlormethiazide or amlodipine treatment in combination with irbesartan treatment on microalbuminuria needs to be reexamined based on a larger sample size after considering basal UACR and SBP levels.
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Affiliation(s)
- Miki Hosaka
- a Department of Development Promotion, Clinical Research, Innovation and Education Center , Tohoku University Hospital , Sendai , Japan
| | - Ryusuke Inoue
- b Department of Medical Informatics , Tohoku University Graduate School of Medicine , Sendai , Japan
| | - Michihiro Satoh
- c Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine , Tohoku Medical and Pharmaceutical University , Sendai , Japan
| | - Daisuke Watabe
- d Department of Planning for Drug Development and Clinical Evaluation , Tohoku University Graduate School of Pharmaceutical Sciences , Sendai , Japan.,e Department of Pharmacy , National Cancer Center Hospital , Tokyo , Japan
| | - Tomohiro Hanazawa
- d Department of Planning for Drug Development and Clinical Evaluation , Tohoku University Graduate School of Pharmaceutical Sciences , Sendai , Japan.,f Japan Development and Medical Affairs , GlaxoSmithKline , Tokyo , Japan
| | - Takayoshi Ohkubo
- g Department of Hygiene and Public Health , Tohoku Institute for Management of BP, Teikyo University School of Medicine , Tokyo , Japan
| | - Kei Asayama
- d Department of Planning for Drug Development and Clinical Evaluation , Tohoku University Graduate School of Pharmaceutical Sciences , Sendai , Japan.,g Department of Hygiene and Public Health , Tohoku Institute for Management of BP, Teikyo University School of Medicine , Tokyo , Japan
| | - Taku Obara
- h Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization , Tohoku University , Sendai , Japan.,i Department of Pharmacy , Tohoku University Hospital , Sendai , Japan
| | - Yutaka Imai
- j Department of Planning for Drug Development and Clinical Evaluation, Tohoku Institute for Management of BP , Tohoku University Graduate School of Pharmaceutical Sciences , Sendai , Japan
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Miyoshi T, Murakami T, Sakuragi S, Doi M, Nanba S, Mima A, Tominaga Y, Oka T, Kajikawa Y, Nakamura K, Ito H. Comparable effect of aliskiren or a diuretic added on an angiotensin II receptor blocker on augmentation index in hypertension: a multicentre, prospective, randomised study. Open Heart 2017; 4:e000591. [PMID: 28409014 PMCID: PMC5384463 DOI: 10.1136/openhrt-2017-000591] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 02/04/2017] [Accepted: 02/21/2017] [Indexed: 12/04/2022] Open
Abstract
Background The effects of antihypertensive drug combination therapy on central blood pressure (BP) and augmentation index (AI) have not been fully elucidated. We investigated the effects of the direct renin inhibitor, aliskiren, or a diuretic added to an angiotensin II receptor blocker on AI in patients with essential hypertension. Methods A 24-week, prospective, multicentre, randomised, open-label study enrolled 103 patients already treated with valsartan. Participants were randomly allocated to receive either valsartan with aliskiren (V+A), or valsartan with trichlormethiazide (V+T). The primary outcome was the change in AI derived from radial artery tonometry. Secondary outcome measures included systolic and diastolic BP, cardio-ankle vascular index (CAVI, which reflects arterial stiffness) and urinary 8-hydroxydeoxyguanosine concentration. Results After 24 weeks, systolic and diastolic BP were significantly reduced in both groups to a broadly comparable extent. There was no significant difference in AI at the end of the study between the V+A group and the V+T group (between-group difference: −2.3%, 95% CI −6.9% to 2.2%, p=0.31). Central BP at the end of the study also did not differ between the two groups (p=0.62). There was no significant difference in the CAVI between the groups at the end of the study. Urinary 8-hydroxydeoxyguanosine concentration was significantly lower in the V+A group than in the V+T group (p<0.01), suggesting that V+A attenuated oxidative stress more than V+T. Conclusion The combination of valsartan and aliskiren had an effect on AI comparable with that of the combination of valsartan and trichlormethiazide. UMIN Clinical Trial Registration number UMIN000005726.
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Affiliation(s)
- Toru Miyoshi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | | | - Satoru Sakuragi
- Department of Cardiology, Iwakuni Medical Center, Iwakuni, Japan
| | - Masayuki Doi
- Department of Cardiology, Kagawa Prefectural Central Hospital, Takamatsu, Japan
| | - Seiji Nanba
- Department of Cardiology, Okayama Rosai Hospital, Okayama, Japan
| | - Atsushi Mima
- Department of Cardiology, Saiseikai Imabari Hospital, Imabari, Japan
| | - Youkou Tominaga
- Department of Cardiology, Yashima General Hospital, Takamatsu, Japan
| | - Takafumi Oka
- Department of Cardiology, Tsuyama Chuo Hospital, Tsuyama, Japan
| | - Yutaka Kajikawa
- Department of Cardiology, Fukuyama Medical Center, Fukuyama, Japan
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Kario K, Tomitani N, Matsumoto Y, Hamasaki H, Okawara Y, Kondo M, Nozue R, Yamagata H, Okura A, Hoshide S. Research and Development of Information and Communication Technology-based Home Blood Pressure Monitoring from Morning to Nocturnal Hypertension. Ann Glob Health 2016; 82:254-73. [DOI: 10.1016/j.aogh.2016.02.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Chi C, Tai C, Bai B, Yu S, Karamanou M, Wang J, Protogerou A, Blacher J, Safar ME, Zhang Y, Xu Y. Angiotensin System Blockade Combined With Calcium Channel Blockers Is Superior to Other Combinations in Cardiovascular Protection With Similar Blood Pressure Reduction: A Meta-Analysis in 20,451 Hypertensive Patients. J Clin Hypertens (Greenwich) 2016; 18:801-8. [PMID: 26778747 DOI: 10.1111/jch.12771] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 11/21/2015] [Accepted: 11/23/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Chen Chi
- Department of Cardiology; Shanghai Tenth People's Hospital; Tongji University School of Medicine; Shanghai China
| | - Chenhui Tai
- Department of Cardiology; Shanghai Tenth People's Hospital; Tongji University School of Medicine; Shanghai China
| | - Bin Bai
- Department of Cardiology; Shanghai Tenth People's Hospital; Tongji University School of Medicine; Shanghai China
| | - Shikai Yu
- Department of Cardiology; Shanghai Tenth People's Hospital; Tongji University School of Medicine; Shanghai China
| | - Marianna Karamanou
- University Institute of History of Medicine and Public Health; Lausanne Switzerland
| | - Jiguang Wang
- Shanghai Institute of Hypertension; Ruijin Hospital; Shanghai Jiaotong University School of Medicine; Shanghai China
| | - Athanase Protogerou
- Department of Pathophysiology; Laiko Hospital; Medical School; National and Kapodistrian University of Athens; Athens Greece
| | - Jacques Blacher
- Diagnosis and Therapeutic Center; Hôtel-Dieu Hospital; AP-HP; Paris Descartes University; Paris France
| | - Michel E. Safar
- Diagnosis and Therapeutic Center; Hôtel-Dieu Hospital; AP-HP; Paris Descartes University; Paris France
| | - Yi Zhang
- Department of Cardiology; Shanghai Tenth People's Hospital; Tongji University School of Medicine; Shanghai China
| | - Yawei Xu
- Department of Cardiology; Shanghai Tenth People's Hospital; Tongji University School of Medicine; Shanghai China
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Thamcharoen N, Susantitaphong P, Wongrakpanich S, Chongsathidkiet P, Tantrachoti P, Pitukweerakul S, Avihingsanon Y, Praditpornsilpa K, Jaber BL, Eiam-Ong S. Effect of N- and T-type calcium channel blocker on proteinuria, blood pressure and kidney function in hypertensive patients: a meta-analysis. Hypertens Res 2015; 38:847-55. [PMID: 26134125 DOI: 10.1038/hr.2015.69] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 05/12/2015] [Accepted: 05/27/2015] [Indexed: 12/28/2022]
Abstract
The combination of a calcium channel blocker (CCB) and a blocker of the renin-angiotensin-aldosterone system (RAAS) is recommended in clinical practice guidelines. L/N- and L/T-type CCBs might provide an additional effect on lowering proteinuria. Therefore, we conducted a meta-analysis to assess the efficacy of L/N- and L/T-type CCBs in hypertensive patients with proteinuria. We searched MEDLINE, Scopus, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov for single-arm studies and randomized controlled trials (RCTs) that examined the effect of L/N- and L/T-type CCBs as add-on therapy compared with standard antihypertensive regimen for proteinuria on hemodynamic and kidney-related parameters in hypertensive patients with proteinuria. Random-effect model meta-analyses were used to compute changes in the outcomes of interest. We identified 17 RCTs, representing 1905 patients. By meta-analysis, L/N- and L/T-type CCB add-on therapy did not yield significant changes in systolic and diastolic blood pressure compared with standard treatment, but there was a significant lowering of the pulse rate. However, L/N- and L/T-type CCBs resulted in a significant standardized net decrease in albuminuria and proteinuria (-1.01; 95% confidence interval (CI), -1.78 to -0.23; P=0.01), and a standardized net improvement in the estimated glomerular filtration rate and serum creatinine (0.23; 95% CI, 0.11 to 0.35, P<0.001; and -0.25; 95% CI, -0.46 to -0.03; P=0.02, respectively). Despite no additional lowering effect on blood pressure, L/N- and L/T-type CCBs combined with a blocker of the RAAS provided a decrease in proteinuria and improvement in kidney function. Further studies are required to establish the long-term kidney benefits of this combination therapy.
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Affiliation(s)
- Natanong Thamcharoen
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Paweena Susantitaphong
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Supakanya Wongrakpanich
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pakawat Chongsathidkiet
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pakpoom Tantrachoti
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Siwadon Pitukweerakul
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yingyos Avihingsanon
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kearkiat Praditpornsilpa
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Bertrand L Jaber
- Department of Medicine, Tufts University School of Medicine, Boston, MA, USA.,Department of Medicine, St Elizabeth's Medical Center, Boston, MA, USA
| | - Somchai Eiam-Ong
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Hayashi M, Uchida S, Kawamura T, Kuwahara M, Nangaku M, Iino Y. Prospective randomized study of the tolerability and efficacy of combination therapy for hypertensive chronic kidney disease: results of the PROTECT-CKD study. Clin Exp Nephrol 2015; 19:925-32. [PMID: 25680887 DOI: 10.1007/s10157-015-1091-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 01/30/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND We conducted a randomized, open-label trial to determine which of the antihypertensive drugs was most beneficial for CKD patients with hypertension in spite of treatment with an angiotensin receptor blocker (ARB). METHODS Patients 20-75 years of age who had CKD according to the definition in the K/DOQI Guidelines and hypertension (systolic blood pressure ≥130 mmHg and/or diastolic blood pressure ≥80 mmHg) with the usual dose of an ARB were randomly assigned to receive losartan 50 mg plus 5 mg of the calcium channel blocker amlodipine (CCB group, n = 37), 5 mg of the angiotensin-converting enzyme inhibitor enalapril (ACEI group, n = 36), or 12.5 mg of the thiazide diuretic hydrochlorothiazide (HCTZ group, n = 36). The primary endpoints were changes in blood pressure (BP), ratio of urinary excretion of protein to creatinine (UPCR), tolerability, and eGFR during the 12-month treatment period compared with control period. RESULTS There were no significant differences in BP and tolerability between the three groups. The percentage changes in UPCR at 12 months after start of the combination therapy were significantly different in the HCTZ group (-26.3 ± 11.1 %, mean ± SE) and CCB group (+46.7 ± 33.6 %, p < 0.05), while eGFR was significantly lower in the HCTZ group than in the ACEI group or CCB group at 4 months but not at 12 months. CONCLUSION Addition of diuretics, CCB, or ACEI to ARB was equally effective for the control of hypertension in CKD, while, in terms of urinary excretion of protein, diuretics may be better than CCB.
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Affiliation(s)
- Matsuhiko Hayashi
- Apheresis and Dialysis Center, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
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Hasegawa H, Tayama Y, Takayanagi K, Asakura J, Nakamura T, Kawashima K, Shimizu T, Iwashita T, Ogawa T, Matsuda A, Mitarai T. Release from glomerular overload by the addition of low-dose thiazide in patients with angiotensin receptor blocker-resistant hypertension. Kidney Blood Press Res 2013; 37:521-30. [PMID: 24281047 DOI: 10.1159/000355732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS This multicenter, prospective, observational study assessed the renoprotective effects of losartan/thiazide combination therapy in terms of lowering the estimated glomerular filtration rate (eGFR). METHODS Adult patients with angiotensin receptor blocker (ARB)-resistant essential hypertension (n = 104) were enrolled and switched to combination therapy with losartan (50 mg/day) and hydrochlorothiazide (12.5 mg/day). RESULTS eGFR values declined significantly during the first 3 months, and changes in eGFR were assessed according to tertiles of the eGFR decrease ratio at 3 months. Only the high eGFR decrease (1st tertile) group showed significantly greater decreases in baseline eGFR and albumin-to-creatinine ratio (ACR) during the first 3 months. Additionally, the assessment according to tertiles of the baseline eGFR showed a signifcant decrease in eGFR and ACR during the first 3 months in the high baseline eGFR (1st tertile) group, but not in the moderate (2nd tertile) and low baseline eGFR (3rd tertile) groups. CONCLUSION The present results revealed that losartan/thiazide combination therapy attenuated glomerular overload, indicating that this therapy may provide glomerular protection in patients with an elevated GFR without causing prolonged damage to renal function.
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Affiliation(s)
- Hajime Hasegawa
- Study Group of the Saitama Anti-hypertension Losartan-hydrochlorothiazide Trial (SALT), Saitama Medical University, Saitama 350-8550 (Japan)
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Kario K. Proposal of a new strategy for ambulatory blood pressure profile-based management of resistant hypertension in the era of renal denervation. Hypertens Res 2013; 36:478-84. [DOI: 10.1038/hr.2013.19] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Efficacy and effects on lipid metabolism of combination treatment with losartan + hydrochlorothiazide versus losartan + amlodipine: a 48-week prospective, multicenter, randomized, open-label trial. Clin Ther 2013; 35:461-73. [PMID: 23490288 DOI: 10.1016/j.clinthera.2013.02.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 02/18/2013] [Accepted: 02/21/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Both combination therapies of an angiotensin II receptor blocker (ARB) with the thiazide diuretic hydrochlorothiazide (HCTZ) and an ARB with a calcium channel blocker (CCB) are recommended to achieve blood pressure (BP) goals in antihypertensive treatment. However, although HCTZ is known to have unfavorable effects on lipid metabolism, the effects of HCTZ in the ARB + HCTZ combination on lipid metabolism have not been fully elucidated. OBJECTIVE The aim of this study was to compare the effects on lipid metabolism of combination treatment with the ARB losartan + HCTZ and losartan + the CCB amlodipine and to assess the efficacy in BP lowering of these 2 combination therapies. The metabolism of glucose, uric acid (UA), and high-sensitivity C-reactive protein (hs-CRP), an inflammation marker of atherosclerosis, were also assessed in association with lipid metabolism. METHODS This 48-week, prospective, randomized, open-label trial was conducted at 2 clinics and 2 hospitals in Tokorozawa City (Saitama, Japan) and Shinjuku-ku Ward (Tokyo, Japan). Eligible patients had a systolic BP (SBP) >140 mm Hg and/or diastolic BP (DBP) >90 mm Hg despite a >1-month history of monotherapy with an ARB. Patients were randomly assigned to receive losartan 50 mg/d + HCTZ 12.5 mg/d (LOS + HCTZ) or losartan 50 mg/d + amlodipine 5 mg/d (LOS + CCB) for 48 weeks. Follow-up visits were scheduled at 4, 8, 12, 24, and 48 weeks. Biochemical measurements were centrally measured at a single institute. Tolerability and treatment compliance were assessed by physicians every 4 weeks. RESULTS A total of 112 patients were enrolled; 26 were excluded from the final analysis, leaving 42 and 44 patients in the LOS + HCTZ and LOS + CCB groups, respectively, included in the final analysis. At 48 weeks, SBP and DBP were significantly decreased in the 2 treatment groups (both, P < 0.0001). The decrease in SBP was significantly greater in the LOS + HCTZ group than in the LOS + CCB group (P < 0.001). The difference in the decrease in DBP between the 2 groups was nonsignificant. There were no significant differences in the changes from baseline (Δ) in any of the lipid parameters between the 2 groups. The decreases at 8 and 12 weeks in LDL-C, TC, and apolipoprotein (apo) B were significantly greater in the LOS + CCB group compared with those in the LOS + HCTZ group. The between-group differences in ΔTG, ΔHDL-C, ΔapoA-1, and ΔapoE throughout the study were nonsignificant. Changes in fasting plasma glucose (FPG), hemoglobin A1c, and hs-CRP were not significantly different between the 2 groups. The between-group difference in ΔUA in men was not significant, but a significant difference was found in women (LOS + HCTZ, 0.74 mg/dL; LOS + CCB, 0.28 mg/dL [P = 0.0017]). No clinically significant adverse events were reported with either treatment throughout the study. CONCLUSIONS The findings from the present study suggest that LOS + HCTZ was more efficacious in decreasing SBP than was LOS + CCB in the management of hypertension refractory to ARB monotherapy. Unfavorable effects on lipid metabolism were not observed with either combination therapy.
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Hase M, Babazono T, Ujihara N, Uchigata Y. Comparison of spironolactone and trichlormethiazide as add-on therapy to renin-angiotensin blockade for reduction of albuminuria in diabetic patients. J Diabetes Investig 2013; 4:316-9. [PMID: 24843672 PMCID: PMC4015670 DOI: 10.1111/jdi.12029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 10/15/2012] [Accepted: 10/17/2012] [Indexed: 01/09/2023] Open
Abstract
To compare the efficacy of spironolactone and trichlormethiazide, as add‐on therapy to renin–angiotensin system (RAS) blockade, for reduction of albuminuria in diabetic patients with chronic kidney disease (CKD), we conducted this randomized, open‐labeled, parallel‐group, active‐controlled, per‐protocol‐design study. Type 2 diabetic patients receiving an angiotensin‐converting enzyme inhibitor or angiotensin II receptor blocker, with persistent albuminuria (≥100 mg/g creatinine) were randomly assigned to either spironolactone (25 mg/day) or trichlormethiazide (2 mg/day). The primary outcome was the change in albuminuria at 24 weeks of treatment. In patients who completed 24 weeks of treatment with spironolactone (n = 18) and trichlormethiazide (n = 15), albuminuria decreased significantly by −57.6 ± 21.3% (SD) (P < 0.001) and −48.4 ± 27.1% (P < 0.001), respectively. There was no significant difference in the change in albuminuria between groups (P = 0.270). This pilot study suggests add‐on therapy with spironolactone or trichlormethiazide to RAS blockade may be comparably beneficial to reducing albuminuria in type 2 diabetic patients. This trial was registered with UMIN‐CTR (no. UMIN000008914).
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Affiliation(s)
- Michiyo Hase
- Division of Nephrology and Hypertension Tokyo Women's Medical University School of Medicine Tokyo Japan ; Department of Medicine, Institute of Geriatrics Tokyo Women's Medical University School of Medicine Tokyo Japan
| | - Tetsuya Babazono
- Division of Nephrology and Hypertension Tokyo Women's Medical University School of Medicine Tokyo Japan
| | - Noriko Ujihara
- Division of Nephrology and Hypertension Tokyo Women's Medical University School of Medicine Tokyo Japan ; Department of Medicine, Institute of Geriatrics Tokyo Women's Medical University School of Medicine Tokyo Japan
| | - Yasuko Uchigata
- Department of Medicine Diabetes Center Tokyo Women's Medical University School of Medicine Tokyo Japan
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Maeda A, Tamura K, Kanaoka T, Ohsawa M, Haku S, Azushima K, Dejima T, Wakui H, Yanagi M, Okano Y, Fujikawa T, Toya Y, Mizushima S, Tochikubo O, Umemura S. Combination Therapy of Angiotensin II Receptor Blocker and Calcium Channel Blocker Exerts Pleiotropic Therapeutic Effects in Addition to Blood Pressure Lowering: Amlodipine and Candesartan Trial in Yokohama (ACTY). Clin Exp Hypertens 2012; 34:249-57. [DOI: 10.3109/10641963.2012.681081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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13
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Mallat SG. What is a preferred angiotensin II receptor blocker-based combination therapy for blood pressure control in hypertensive patients with diabetic and non-diabetic renal impairment? Cardiovasc Diabetol 2012; 11:32. [PMID: 22490507 PMCID: PMC3351968 DOI: 10.1186/1475-2840-11-32] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Accepted: 04/10/2012] [Indexed: 01/13/2023] Open
Abstract
Hypertension has a major associated risk for organ damage and mortality, which is further heightened in patients with prior cardiovascular (CV) events, comorbid diabetes mellitus, microalbuminuria and renal impairment. Given that most patients with hypertension require at least two antihypertensives to achieve blood pressure (BP) goals, identifying the most appropriate combination regimen based on individual risk factors and comorbidities is important for risk management. Single-pill combinations (SPCs) containing two or more antihypertensive agents with complementary mechanisms of action offer potential advantages over free-drug combinations, including simplification of treatment regimens, convenience and reduced costs. The improved adherence and convenience resulting from SPC use is recognised in updated hypertension guidelines. Despite a wide choice of SPCs for hypertension treatment, clinical evidence from direct head-to-head comparisons to guide selection for individual patients is lacking. However, in patients with evidence of renal disease or at greater risk of developing renal disease, such as those with diabetes mellitus, microalbuminura and high-normal BP or overt hypertension, guidelines recommend renin-angiotensin system (RAS) blocker-based combination therapy due to superior renoprotective effects compared with other antihypertensive classes. Furthermore, RAS inhibitors attenuate the oedema and renal hyperfiltration associated with calcium channel blocker (CCB) monotherapy, making them a good choice for combination therapy. The occurrence of angiotensin-converting enzyme (ACE) inhibitor-induced cough supports the use of angiotensin II receptor blockers (ARBs) for RAS blockade rather than ACE inhibitors. In this regard, ARB-based SPCs are available in combination with the diuretic, hydrochlorothiazide (HCTZ) or the calcium CCB, amlodipine. Telmisartan, a long-acting ARB with preferential pharmacodynamic profile compared with several other ARBs, and the only ARB with an indication for the prevention of CV disease progression, is available in two SPC formulations, telmisartan/HCTZ and telmisartan/amlodipine. Clinical studies suggest that in CV high-risk patients and those with evidence of renal disease, the use of an ARB/CCB combination may be preferred to ARB/HCTZ combinations due to superior renoprotective and CV benefits and reduced metabolic side effects in patients with concomitant metabolic disorders. However, selection of the most appropriate antihypertensive combination should be dependent on careful review of the individual patient and appropriate consideration of drug pharmacology.
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Affiliation(s)
- Samir G Mallat
- Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
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Hosoya T, Kuriyama S, Ohno I, Kawamura T, Ogura M, Ikeda M, Ishikawa M, Hayashi F, Kanai T, Tomonari H, Soejima M, Akaba K, Tokudome G. Antihypertensive effect of a fixed-dose combination of losartan/hydrochlorothiazide in patients with uncontrolled hypertension: a multicenter study. Clin Exp Nephrol 2012; 16:269-78. [PMID: 22127399 PMCID: PMC3328675 DOI: 10.1007/s10157-011-0564-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 11/10/2011] [Indexed: 01/13/2023]
Abstract
BACKGROUND Achieving adequate blood pressure (BP) control often requires more than one antihypertensive agent. The purpose of this study was to determine whether a fixed-dose formulation of losartan (LOS) plus hydrochlorothiazide (HCTZ) (LOS/HCTZ) is effective in achieving a greater BP lowering in patients with uncontrolled hypertension. METHODS The study was a prospective, multicenter, observational trial exploring the antihypertensive effect of a single tablet of LOS 50 mg/HCTZ 12.5 mg. A total of 228 patients whose BP had previously been treated with more than one antihypertensive agents without having achieved BP goal below 130/80 mmHg enrolled in the study. RESULTS A significant decrease in systolic and diastolic BP was observed in both clinic and home measurement after switching from the previous treatment to LOS/HCTZ. There was a significant decrease in both B-type natriuretic peptide (BNP) and urinary albumin creatinine (Cr) excretion ratio (ACR), especially in patients with elevated values. In contrast, there was a significant increase in serum Cr concentration in conjunction with a decrease in estimated glomerular filtration rate (eGFR). Overall serum uric acid (UA) concentration increased, whereas in patients with hyperuricemia there was a significant reduction in this value. CONCLUSION Switching to LOS/HCTZ provides a greater reduction in clinic and home BP in patients with uncontrolled hypertension. This combination therapy may lead to cardio-, reno protection and improve UA metabolism.
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Affiliation(s)
- Tatsuo Hosoya
- Department of Kidney and Hypertension, Jikei University School of Medicine, Tokyo, Japan
| | - Satoru Kuriyama
- Department of Kidney and Hypertension, Jikei University School of Medicine, Tokyo, Japan
- Division of Nephrology, Saiseikai Central Hospital, 1-4-17 Mita, Minato-ku, Tokyo, 108-0073 Japan
| | - Iwao Ohno
- Department of Kidney and Hypertension, Jikei University School of Medicine, Tokyo, Japan
| | - Tetsuya Kawamura
- Department of Kidney and Hypertension, Jikei University School of Medicine, Tokyo, Japan
| | - Makoto Ogura
- Department of Kidney and Hypertension, Jikei University School of Medicine, Tokyo, Japan
| | - Masato Ikeda
- Department of Kidney and Hypertension, Jikei University School of Medicine, Tokyo, Japan
| | - Masahiro Ishikawa
- Department of Kidney and Hypertension, Jikei University School of Medicine, Tokyo, Japan
- Kawaguchi Medical Center, Saitama, Japan
| | - Fumihiro Hayashi
- Department of Kidney and Hypertension, Jikei University School of Medicine, Tokyo, Japan
- Tokyu Hospital, Tokyo, Japan
| | | | | | | | | | - Goro Tokudome
- Department of Kidney and Hypertension, Jikei University School of Medicine, Tokyo, Japan
- Tokyu Hospital, Tokyo, Japan
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Reduction of albuminuria with antihypertensive treatment: is more always better? Am J Hypertens 2011; 24:377-8. [PMID: 21423131 DOI: 10.1038/ajh.2010.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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