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Losartan with hydrochlorothiazide in the treatment of hypertension
1Department of Preventive Medicine, Rush-Presbyterian St Luke's Medical Center, Chicago, IL, USA.
Insights
The combination of losartan and hydrochlorothiazide effectively lowers blood pressure more than either drug alone. This combination therapy for hypertension was found to be well-tolerated with no significant increase in adverse events.
Area of Science:
- Cardiovascular medicine
- Pharmacology
Background:
- Hypertension is a significant risk factor for cardiovascular disease.
- Losartan and hydrochlorothiazide are commonly prescribed antihypertensive agents.
- Understanding the additive effects of combination therapy is crucial for optimizing treatment.
Purpose of the Study:
- To evaluate the efficacy and safety of combined losartan and hydrochlorothiazide therapy.
- To compare the combination therapy against monotherapy with losartan or hydrochlorothiazide, and placebo.
- To assess blood pressure reduction in patients with mild to moderate hypertension.
Main Methods:
- A 12-week, randomized, double-blind, placebo-controlled trial.
- 703 participants with mild to moderate hypertension were enrolled.
- Treatment groups included various combinations of losartan, hydrochlorothiazide, and placebo.
Main Results:
- The combination of 50 mg losartan + 12.5 mg hydrochlorothiazide demonstrated the greatest reduction in both systolic and diastolic blood pressure.
- Blood pressure reductions with combination therapy were additive and superior to monotherapy.
- No significant differences in adverse events were observed between treatment groups.
Conclusions:
- Concomitant administration of losartan and hydrochlorothiazide provides additive antihypertensive effects.
- The combination of 50 mg losartan + 12.5 mg hydrochlorothiazide is an effective and well-tolerated treatment for hypertension.
- Combination therapy offers a superior approach to managing mild to moderate hypertension.
Aim:
To review the efficacy and safety of losartan and hydrochlorothiazide compared to losartan alone, hydrochlorothiazide alone or placebo in the treatment of mild to moderate hypertension in a clinical trial.
Patients And Methods:
A randomly allocated, placebo-controlled, double-blind parallel study was performed in 40 clinical centers throughout the United States. A total of 703 males and females aged 18-75 years with a sitting diastolic blood pressure of 95-115 mmHg entered the trial and 604 completed the 12-week protocol. The participants were randomly assigned to concomitant therapy once a day with: (1) 50 mg losartan and 6.25 mg hydrochlorothiazide, (2) 50 mg losartan and 12.5 mg hydrochlorothiazide, (3) 50 mg losartan alone, (4) 12.5 mg hydrochlorothiazide alone or (5) placebo. All participants were followed for 12 weeks.
Results:
At baseline, mean trough sitting diastolic blood pressure was 100.9-101.7 mmHg, with no significant difference between treatment groups. Sitting diastolic blood pressure fell 4.0 mmHg with placebo, 7.2 mmHg with 12.5 mg hydrochlorothiazide, 7.2 mmHg with 50 mg losartan, 9.3 mmHg with 50 mg losartan + 6.25 mg hydrochlorothiazide, and 13.2 mmHg with 50 mg losartan + 12.5 mg hydrochlorothiazide. The fall in mean trough sitting systolic blood pressure was 2.4, 9.3, 10.7, 12.0 and 17.9 mmHg for the respective groups. After subtracting the placebo effect, the reductions in blood pressure induced by losartan and hydrochlorothiazide were additive for both sitting diastolic and systolic blood pressures and approximately equaled the reduction seen with the combination of losartan and hydrochlorothiazide. There were no significant differences in adverse events between treatment groups.
Conclusions:
The concomitant administration of 50 mg losartan + 12.5 mg hydrochlorothiazide produced additive falls in sitting diastolic and systolic blood pressures which were greater than that achieved with either drug alone. On the basis of the adverse effects reported, the combination was well tolerated.
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