Antihypertensive and metabolic effects of Angiotensin receptor blocker/diuretic
combination therapy in obese, hypertensive African American and white patients.
Author(s): Ofili EO(1), Zappe DH, Purkayastha D, Samuel R, Sowers JR.
Affiliation(s): Author information:
(1)Department of Medicine, Clinical Research Center, Morehouse School of Medicine,
Atlanta, GA 30310-1495, USA. eofili@msm.edu
Publication date & source: 2013, Am J Ther. , 20(1):2-12
A clinical trial showed comparable blood pressure (BP) lowering by
valsartan/hydrochlorothiazide and amlodipine/hydrochlorothiazide in obese
hypertensive patients. Relative to amlodipine/hydrochlorothiazide,
valsartan/hydrochlorothiazide reduced the hyperglycemic response to glucose
challenge. An objective of this post hoc analysis was to determine whether this
benefit extended to African Americans and whites. Treatments (160/12.5 mg of
valsartan/hydrochlorothiazide force titrated to 320/25 mg of
valsartan/hydrochlorothiazide at week 4 or 12.5 mg of hydrochlorothiazide force
titrated to 25 mg of hydrochlorothiazide at week 4 with 5 and 10 mg of amlodipine
added at weeks 8 and 12, respectively) were administered once daily. Both
treatments reduced clinic BP from baseline to all visits (P < 0.0001), regardless
of race/ethnicity (126 African Americans, 212 whites). In African Americans,
there were no significant between-treatment differences in clinic or ambulatory
BP lowering at weeks 8 or 16. Whites responded better to
valsartan/hydrochlorothiazide. In both racial/ethnic subgroups, the addition of
valsartan but not amlodipine mitigated the hyperglycemic response to
hydrochlorothiazide through enhanced insulin secretion.
Valsartan/hydrochlorothiazide was as effective as amlodipine/hydrochlorothiazide
was in reducing BP in obese, hypertensive African Americans and better than
amlodipine/hydrochlorothiazide in whites. In both racial/ethnic subgroups, the
addition of valsartan to hydrochlorothiazide reduced the negative metabolic
effects associated with thiazide therapy.
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