학술대회안내사전등록초록등록안내초록등록/관리숙박 및 교통
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Reduction of the systolic blood pressure and arterial stiffness of losartan/hydrochlorothiazide and amlodipine in patients with isolated systolic hypertension
Samsung Cheil Hospital, Sungkyunkwan University School of Medicine,¹ Korea University Guro Hospital,² Seoul National University Hospital³
Jeong Bae Park,¹, Chang Gyu Park,² Yong-Jin Kim,³ Cheol Ho Kim³
Background: Isolated systolic hypertension (ISH), characterized by a wide pulse pressure, is an independent risk factor for cardiovascular disease, resulting largely from excessive large artery stiffness. Calcium channel blocker has shown significant benefits in reducing systolic blood pressure (SBP), and cardiovascular mortality and morbidity.In this study, we compared the efficacy on SBP and arterial stiffness of a fixed combination of losartan/hydrochlorothiazide (HCTZ) and amlodipine in the treatment of patients with ISH. Method: One hundred nine untreated systolic hypertensive patients (61.3 years, range 30-65; 33% male) were randomly assigned to losartan 50 mg/HCTZ 12.5 mg or amlodipine 5 mg, which was doubled at week 4 to achieve a target SBP <140 mm Hg. The primary efficacy measure was change in trough SBP and tolerability from baseline to week 8. In a subgroup of the patients (n=41), arterial stiffness (augmentation index; AI) and wave reflections (time to the reflected wave; Tr) were quantified noninvasively using applanation tonometry of the radial artery with a transfer function. Results: Both treatments reduced blood pressure (BP) to a comparable degree (losartan/HCTZ: 157±12/86±4 to 128±17/74±9mmHg, p<0.01; amlodipine: 156±12/84±6 to 131±13/76±7mmHg, p<0.01). Pulse pressure was also similarly reduced to 54 mmHg from 74 (both p<0.01). The incidence of CAEs and drug-related CAEs was similar in both groups (losartan/HCTZ, 21.8% and 20.0%; amlodipine, 18.5% and 16.7%). Pulse wave analysis in a subgroup showed that central AI by losartan/HCTZ treatment was significantly reduced to 28±10% (from 34±12% p=0.02). In contrast, amlodipine showed no effect (36±12 to 36±11%). Central wave reflection, Tr, after treatment was increased to 133±11msec in losartan/HCTZ group compared to 124±14msec in amlodipine group (p=0.01). Conclusions: In patients with ISH, losartan/HCTZ and amlodipine produced comparable reductions in SBP and tolerability. However, losartan/HCTZ reversed the altered arterial stiffness and wave reflection, whereas the calcium channel antagonist amlodipine had no effect. Therefore, a fixed combination of losartan/HCTZ may be considered for the initial treatment of ISH.


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