Efficacy of ARB/HCTZ Combination Therapy in Uncontrolled Hypertensive Patients Compared with ARB Monotherapy: A...

Area of Science:

• Cardiology
• Pharmacology
• Clinical Trials

Background:

• Uncontrolled hypertension remains a significant global health challenge, necessitating effective therapeutic strategies.
• Angiotensin receptor blockers (ARBs) are a cornerstone of hypertension management, but some patients require additional agents for optimal blood pressure control.

Purpose of the Study:

• To systematically review and meta-analyze the efficacy and safety of combining ARBs with hydrochlorothiazide (HCTZ) compared to ARB monotherapy in patients with uncontrolled hypertension.

Main Methods:

• A comprehensive literature search was conducted across major databases up to July 2019.
• Randomized controlled trials (RCTs) comparing ARB/HCTZ combination therapy with ARB monotherapy for at least 4 weeks were included.
• Meta-analyses were performed for efficacy outcomes, with separate analyses for different HCTZ concentrations (12.5 mg and 25 mg).

Main Results:

• Sixteen RCTs involving 12,055 participants were analyzed.
• ARB/HCTZ combination therapy demonstrated superior reductions in both systolic and diastolic blood pressure compared to ARB monotherapy (e.g., -5.69 mmHg systolic with 12.5 mg HCTZ).
• The combination therapy significantly increased the rate of achieving target blood pressure (Risk Ratio: 1.50) with no significant difference in total or severe adverse events.

Conclusions:

• Combination therapy with ARBs and HCTZ is more effective in controlling blood pressure than ARB monotherapy.
• Adding low-dose HCTZ (12.5 mg) to ARBs offers enhanced efficacy with a similar safety profile to ARB monotherapy.
• Clinicians should consider ARB/HCTZ combination therapy for patients with uncontrolled hypertension whose clinical profiles permit.