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High-dose monotherapy vs low-dose combination therapy of calcium channel blockers and angiotensin receptor blockers in mild to moderate hypertension

Journal of Human Hypertension volume 19, pages 491–496 (2005)Cite this article

Abstract

The objectives of the study were to compare long-acting dihydropyridine calcium channel blockers (CCBs) with angiotensin II receptor blockers (ARBs) according to the ambulatory blood pressure monitoring (ABPM) profile in stage 1 and 2 newly diagnosed hypertensives and also to evaluate the efficacy of high-dose monotherapy vs low-dose combination therapy of the two drug categories among the subjects with inadequate blood pressure (BP) control after conventional low-dose monotherapy. We obtained 24-h ABPM readings from 302 subjects with newly diagnosed stage 1 or 2 essential hypertension. The study protocol consisted of initial drug treatment with a low dose of either CCBs or ARBs. Hypertensives who did not achieve BP control were randomized to high-dose monotherapy of either category of drug or low-dose combination therapy. CCBs and ARBs in low-dose monotherapy achieved BP control in 53.8 and 55.3% of the cases, respectively. However, subjects under treatment with CCBs experienced side effects more often and required that treatment be discontinued. Hypertensives who failed to control their BP with low-dose monotherapy did significantly better with low-dose combination treatment (61.6%) than with high-dose CCBs (42.8%) or ARBs (40.5%) monotherapy (P<0.05). In terms of ABPM, low-dose combination therapy exhibited better 24-h BP profile according to trough-to-peak ratio, hypertensive burden and BP variability. In conclusion, low-dose ARBs and CCBs have a comparable effect in subjects with grade 1 and 2 arterial hypertension. In hypertensives who are not controlled by low-dose monotherapy, low-dose combination therapy proves be more efficacious than high-dose monotherapy.

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Acknowledgements

This work was supported by AstraZeneca Pharmaceutical Co, Greece.

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Authors and Affiliations

  1. 4th Department of Internal Medicine, ‘Evangelismos’ State General Hospital, Athens, Greece

    E A Andreadis, G I Tsourous, G E Marakomichelakis, P M Katsanou, M E Fotia, C V Vassilopoulos & E J Diamantopoulos

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  1. E A Andreadis
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  2. G I Tsourous
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  3. G E Marakomichelakis
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  4. P M Katsanou
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  5. M E Fotia
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  6. C V Vassilopoulos
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  7. E J Diamantopoulos
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Correspondence to E J Diamantopoulos.

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Andreadis, E., Tsourous, G., Marakomichelakis, G. et al. High-dose monotherapy vs low-dose combination therapy of calcium channel blockers and angiotensin receptor blockers in mild to moderate hypertension. J Hum Hypertens 19, 491–496 (2005). https://doi.org/10.1038/sj.jhh.1001843

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