Combination angiotensin-receptor blocker (ARB)/calcium channel blocker with HCTZ vs the maximal recommended dose of an ARB with HCTZ in patients with stage 2 hypertension: The exforge as compared to losartan treatment in stage 2 systolic hypertension (EXALT) study

Richard F. Wright, Daniel Duprez, Das Purkayastha, Rita Samuel, Keith C. Ferdinand

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Abstract

This study compared the efficacy and safety of combination angiotensin-receptor blocker (ARB)/calcium-channel blocker (CCB) with hydrochlorothiazide (valsartan/amlodipine/HCTZ 160/5/25mg) vs maximal available combination doses of an ARB with HCTZ (losartan/HCTZ 100/25mg) in the management of stage2 hypertension. After 1 to 2weeks of antihypertensive drug washout, patients with a mean sitting systolic blood pressure (MSSBP) of ≥160 mm Hg and <200mmHg were randomized to valsartan/amlodipine 160/5mg (n=241) or losartan 100mg (n=247). At week3, HCTZ 25mg was added to both treatments. The primary end point, reduction in MSSBP from baseline to week6, was significantly greater in the valsartan/amlodipine group than in the losartan group (least-squares [LS] mean change, -31.8 mm Hg vs -26.4mmHg; P<.001). Additional reductions occurred after titrating to 320/10/25 mg at week6 in the valsartan/amlodipine group and switching from losartan/HCTZ to valsartan/amlodipine/HCTZ (week6, 160/5/25mg; week9, 320/10/25mg) in the losartan group. Achievement of blood pressure <140/90 mmHg also favored the valsartan/amlodipine group. Dizziness was the only adverse event reported in >5% of patients (5.4% valsartan/amlodipine group, 3.6% losartan group). Moderate doses of an ARB/CCB combination with HCTZ reduced blood pressure more effectively than the maximal dose of an ARB with HCTZ.

Original languageEnglish (US)
Pages (from-to)588-597
Number of pages10
JournalJournal of Clinical Hypertension
Volume13
Issue number8
DOIs
StatePublished - Aug 1 2011

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Hydrochlorothiazide
Losartan
Angiotensin Receptor Antagonists
Calcium Channel Blockers
Hypertension
Blood Pressure
Therapeutics
Antihypertensive Agents
Valsartan Drug Combination Amlodipine
Safety

Cite this

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title = "Combination angiotensin-receptor blocker (ARB)/calcium channel blocker with HCTZ vs the maximal recommended dose of an ARB with HCTZ in patients with stage 2 hypertension: The exforge as compared to losartan treatment in stage 2 systolic hypertension (EXALT) study",
abstract = "This study compared the efficacy and safety of combination angiotensin-receptor blocker (ARB)/calcium-channel blocker (CCB) with hydrochlorothiazide (valsartan/amlodipine/HCTZ 160/5/25mg) vs maximal available combination doses of an ARB with HCTZ (losartan/HCTZ 100/25mg) in the management of stage2 hypertension. After 1 to 2weeks of antihypertensive drug washout, patients with a mean sitting systolic blood pressure (MSSBP) of ≥160 mm Hg and <200mmHg were randomized to valsartan/amlodipine 160/5mg (n=241) or losartan 100mg (n=247). At week3, HCTZ 25mg was added to both treatments. The primary end point, reduction in MSSBP from baseline to week6, was significantly greater in the valsartan/amlodipine group than in the losartan group (least-squares [LS] mean change, -31.8 mm Hg vs -26.4mmHg; P<.001). Additional reductions occurred after titrating to 320/10/25 mg at week6 in the valsartan/amlodipine group and switching from losartan/HCTZ to valsartan/amlodipine/HCTZ (week6, 160/5/25mg; week9, 320/10/25mg) in the losartan group. Achievement of blood pressure <140/90 mmHg also favored the valsartan/amlodipine group. Dizziness was the only adverse event reported in >5{\%} of patients (5.4{\%} valsartan/amlodipine group, 3.6{\%} losartan group). Moderate doses of an ARB/CCB combination with HCTZ reduced blood pressure more effectively than the maximal dose of an ARB with HCTZ.",
author = "Wright, {Richard F.} and Daniel Duprez and Das Purkayastha and Rita Samuel and Ferdinand, {Keith C.}",
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T1 - Combination angiotensin-receptor blocker (ARB)/calcium channel blocker with HCTZ vs the maximal recommended dose of an ARB with HCTZ in patients with stage 2 hypertension

T2 - The exforge as compared to losartan treatment in stage 2 systolic hypertension (EXALT) study

AU - Wright, Richard F.

AU - Duprez, Daniel

AU - Purkayastha, Das

AU - Samuel, Rita

AU - Ferdinand, Keith C.

PY - 2011/8/1

Y1 - 2011/8/1

N2 - This study compared the efficacy and safety of combination angiotensin-receptor blocker (ARB)/calcium-channel blocker (CCB) with hydrochlorothiazide (valsartan/amlodipine/HCTZ 160/5/25mg) vs maximal available combination doses of an ARB with HCTZ (losartan/HCTZ 100/25mg) in the management of stage2 hypertension. After 1 to 2weeks of antihypertensive drug washout, patients with a mean sitting systolic blood pressure (MSSBP) of ≥160 mm Hg and <200mmHg were randomized to valsartan/amlodipine 160/5mg (n=241) or losartan 100mg (n=247). At week3, HCTZ 25mg was added to both treatments. The primary end point, reduction in MSSBP from baseline to week6, was significantly greater in the valsartan/amlodipine group than in the losartan group (least-squares [LS] mean change, -31.8 mm Hg vs -26.4mmHg; P<.001). Additional reductions occurred after titrating to 320/10/25 mg at week6 in the valsartan/amlodipine group and switching from losartan/HCTZ to valsartan/amlodipine/HCTZ (week6, 160/5/25mg; week9, 320/10/25mg) in the losartan group. Achievement of blood pressure <140/90 mmHg also favored the valsartan/amlodipine group. Dizziness was the only adverse event reported in >5% of patients (5.4% valsartan/amlodipine group, 3.6% losartan group). Moderate doses of an ARB/CCB combination with HCTZ reduced blood pressure more effectively than the maximal dose of an ARB with HCTZ.

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