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Double-blind comparison of amlodipine and hydrochlorothiazide in patients with mild to moderate hypertension
C V Ram1, R P Ames, W B Applegate
1University of Texas Southwestern Medical Center, Dallas 75235-8899.
Insights
Amlodipine and hydrochlorothiazide (HCTZ) both control blood pressure, but HCTZ increased cholesterol and potassium levels. Amlodipine showed comparable efficacy and was metabolically neutral.
Area of Science:
- Pharmacology
- Cardiovascular Medicine
- Clinical Trials
Background:
- Hypertension management is crucial for cardiovascular health.
- Amlodipine and hydrochlorothiazide (HCTZ) are common antihypertensive agents.
- Comparative efficacy and metabolic profiles are important for treatment selection.
Purpose of the Study:
- To compare the efficacy of amlodipine versus HCTZ in achieving blood pressure control.
- To evaluate the metabolic effects of amlodipine and HCTZ on blood lipids and electrolytes.
- To assess the safety and tolerability of both agents.
Main Methods:
- Randomized controlled trial comparing amlodipine and HCTZ.
- Patients were assessed at Week 26 for blood pressure control.
- Biochemical parameters including lipids and electrolytes were monitored.
Main Results:
- Blood pressure control was achieved in 26% of patients on amlodipine versus 33% on HCTZ.
- HCTZ significantly increased total plasma cholesterol and altered potassium levels.
- Neither drug caused significant changes in pulse rate or ECG; side effect profiles were comparable.
Conclusions:
- Both amlodipine and HCTZ are effective in blood pressure control.
- Amlodipine demonstrates a metabolically neutral profile compared to HCTZ's adverse effects on lipids and electrolytes.
- Amlodipine may be a preferred option for patients concerned about metabolic changes.
Abstract:
In the final analysis of this study at Week 26, 26% of the patients randomized to receive amlodipine attained blood pressure control with amlodipine alone compared with 33% of the patients allocated to hydrochlorothiazide (HCTZ). Neither amlodipine nor HCTZ produced clinically significant changes in pulse rate or in the electrocardiogram. Amlodipine treatment did not appear to produce clinically significant changes in blood lipids; HCTZ, however, produced an increase in total plasma cholesterol (delta 22.9 +/- 8.6 mg/dl). The incidence of side effects and the rate of patient withdrawal in the amlodipine and HCTZ groups were comparable. As expected, HCTZ therapy caused well-recognized biochemical alterations in cholesterol and potassium levels, whereas amlodipine was metabolically neutral.