Effects of antihypertensive drugs on SBP variability are dose-dependent and persist when used in combinations .
Use of a high dose of a calcium channel blocker alone or in combination with other agents is therefore likely to be particularly effective in prevention of stroke
BACKGROUND AND PURPOSE Recent studies have shown that visit-to-visit blood pressure variability is a powerful risk factor for stroke , is reduced by calcium channel blockers and diuretics , and increased by β-blockers .
However , it is unknown whether these effects are dose-dependent and persist in combination with other drugs .
Antiproteinuric and blood pressure-lowering effects of a fixed-dose combination of losartan and hydrochlorothiazide in hypertensive patients with stage 3 chronic kidney disease.
STUDY OBJECTIVE To compare the renoprotective and blood pressure-lowering effects of combination losartan-low-dose hydrochlorothiazide with losartan alone in hypertensive patients with stage 3 chronic kidney disease ( CKD ) . DESIGN Prospect i ve , open-label , r and omized , controlled study . SETTING Outpatient clinic at a university-affiliated hospital in Japan . PATIENTS Sixty adults ( mean age 67 yrs ) with stage 3 CKD who had been receiving losartan 50 mg/day and had not achieved their target blood pressure of 130/80 mm Hg . INTERVENTION Patients were r and omly assigned to receive combination losartan 50 mg-hydrochlorothiazide 12.5 mg/day in addition to losartan 50 mg/day ( combination therapy group , 30 patients ) or to receive losartan 100 mg/day ( control group , 30 patients ) over a 24-week period . MEASUREMENTS AND MAIN RESULTS Efficacy was determined by monitoring clinical and laboratory parameters . Mean baseline systolic and diastolic blood pressures were 158/90 mm Hg in both groups ; at 24 weeks of treatment , these blood pressures significantly decreased to 133/79 mm Hg in the combination therapy group compared with both baseline and the values in the control group ( 145/83 mm Hg ) . Although serum creatinine concentration increased and the estimated glomerular filtration rate decreased significantly in both groups , the urinary protein : creatinine ratio was significantly lower in the combination therapy group . With stratification of patients on the basis of whether they had diabetes mellitus , we found that the reduction in the urinary protein : creatinine ratio was more evident in the combination therapy group . No significant increase in the occurrence of adverse metabolic effects was noted in either group . CONCLUSION In these hypertensive patients with stage 3 CKD , combination therapy with the maximum recommended daily dose of losartan of 100 mg and a low dose of hydrochlorothiazide of 12.5 mg ameliorated proteinuria and reduced blood pressure more effectively than treatment with losartan 100 mg alone , irrespective of whether the patients had diabetes
Effects of antihypertensive drugs on SBP variability are dose-dependent and persist when used in combinations .
Use of a high dose of a calcium channel blocker alone or in combination with other agents is therefore likely to be particularly effective in prevention of stroke
BACKGROUND AND PURPOSE Recent studies have shown that visit-to-visit blood pressure variability is a powerful risk factor for stroke , is reduced by calcium channel blockers and diuretics , and increased by β-blockers .
However , it is unknown whether these effects are dose-dependent and persist in combination with other drugs .