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 .
A double-blind, randomized study evaluating losartan potassium monotherapy or in combination with hydrochlorothiazide versus placebo in obese patients with hypertension.
OBJECTIVES The objective of this study was to evaluate the effects of losartan + /- hydrochlorothiazide ( HCTZ ) versus placebo in obese patients with systolic and diastolic hypertension . RESEARCH DESIGN AND METHODS R and omized patients ( n = 261 ) were non-diabetic with systolic blood pressure ( SBP ) > or = 140 and < or = 180 mmHg and diastolic BP ( DBP ) > or = 95 and < or = 115 mmHg , body mass index > 30 kg/m(2 ) , and waist circumference > 40 (males)/ > 35 ( females ) inches . Patients were r and omized to placebo or a forced titration of losartan 50 mg titrated at 4-week intervals to losartan 100 mg , losartan 100 mg/HCTZ 12.5 mg , and losartan 100 mg/HCTZ 25 mg . Primary efficacy measurements were change from baseline in SBP and DBP at 12 weeks . Secondary measurements were change from baseline in BPs at 8 and 16 weeks , percent responders at 12 and 16 weeks , and safety/tolerability . Post-hoc analyses were BP at 4 weeks and achievement of controlled BP ( SBP < 140 and /or DBP < 90 mmHg ) at 12 and 16 weeks . RESULTS Losartan 50 mg reduced BP from 151.6/99.2 mmHg at baseline to 140.1/89.8 mmHg at week 4 ( post hoc ) , 139.5/89.6 mmHg with losartan 100 mg at week 8 ( secondary ) , 134.3/85.9 mmHg with losartan 100 mg/HCTZ 12.5 mg at week 12 ( primary ) , and 132.1/84.9 mmHg with losartan 100 mg/HCTZ 50 mg at week 16 ( secondary ) ( all p < 0.05 ) . Rates of clinical adverse experiences were similar between treatment groups . A limitation of these analyses is the relatively rapid rate of study drug titration , which may not have allowed for the evaluation of the full treatment effect at each titration step . CONCLUSIONS We conclude that losartan alone or in combination with HCTZ was generally well tolerated and effective in the treatment of elevated systolic and diastolic BP in obese patients with hypertension
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 .