Comparative effectiveness of a fixed-dose combination of losartan + HCTZ versus bisoprolol + HCTZ in patients with moderate-to-severe hypertension: results of the 6-month ELIZA trial

Abstract

BackgroundThe aim of this study was to compare the antihypertensive efficacy of losartan 100 mg + hydrochlorothiazide (HCTZ) 25 mg versus bisoprolol 10 mg + HCTZ 25 mg and their influence on arterial stiffness and central blood pressure (BP).MethodsOf 60 patients with a mean BP of 173.3 ± 1.7/98.4 ± 1.2 mmHg, 59 were random-ized to losartan + HCTZ (n = 32) or bisoprolol + HCTZ (n = 27). Amlodipine was added if target BP was not achieved at 1 month, and doxazosin was added if target BP was not achieved after 3 months. Body mass index, office and 24-hour ambulatory BP, pulse wave velocity (carotid-femoral [PWVE] and radial [PWVM]), noninvasive central systolic BP, augmentation index (AIx), laboratory investigations, and electrocardiography were done at baseline and after 6 months of treatment.ResultsLosartan + HCTZ was as effective as bisoprolol + HCTZ, with target office BP achieved in 96.9% and 92.6% of patients and target 24-hour BP in 75% and 66.7% of patients, respectively, after 6 months. Effective treatment of BP led to significant lowering of central systolic BP, but this was decreased to a significantly (P < 0.05) greater extent by losartan + HCTZ (−23.0 ± 2.3 mmHg) than by bisoprolol + HCTZ (−15.4 ± 2.9 mmHg) despite equal lowering of brachial BP. Factors correlated with central systolic BP and its lowering differed between the treatment groups. Losartan + HCTZ did not alter arterial stiffness patterns significantly, but bisoprolol + HCTZ significantly increased AIx. We noted differences in ΔPWVE, ΔPWVM, and ΔAIx between the groups in favor of losartan + HCTZ. Decreased heart rate was associated with higher central systolic BP and AIx in the bisoprolol + HCTZ group, but was not associated with increased AIx in the losartan + HCTZ group.ConclusionAlthough both treatments decreased both office and 24-hour BP, losartan + HCTZ significantly decreased central systolic BP and had a more positive influence on pulse wave velocity, with a less negative effect of decreased heart rate on AIx and central systolic BP.

Antihypertensive Treatment and Central Arterial Hemodynamics: A Meta-Analysis of Randomized Controlled Trials

“…After having reviewed the title and abstract, 3,845 were excluded. Of the 162 full-text articles retrieved, 142 original articles were excluded for various reasons ( Figure 1 ), leaving 20 eligible original articles in the analysis ( Chen et al, 1995 ; Klingbeil et al, 2002 ; Ariff et al, 2006 ; Dart et al, 2007 ; Jiang et al, 2007 ; Schneider et al, 2008 ; Mackenzie et al, 2009 ; Matsui et al, 2009 ; Boutouyrie et al, 2010 ; Doi et al, 2010 ; Vitale et al, 2012 ; Kubota et al, 2013 ; Radchenko et al, 2013 ; Kim et al, 2014 ; Koumaras et al, 2014 ; Ghiadoni et al, 2017 ; Jekell et al, 2017 ; Miyoshi et al, 2017 ; Webster et al, 2017 ; Choi et al, 2018 ), comparing RAS inhibitors ( n = 21) or CCBs ( n = 6) with diuretics, β-blockers, or an α-blocker ( Table 1 ).…”

Influence of obesity in central blood pressure

“…Adaption of the arterial wall to excess body weight may change over a lifetime, as older patients seem to present greater arterial stiffness with increasing weight [25,41,42]. The impact of BP treatment on central BP and PWV is controversial and depends on both drug class and vascular phenotype [44,45]. Recently, a study carried out in twins to evaluate the relationship between BMI, and BP and arterial stiffness revealed important heterogeneity in individual responses to obesity [43].…”

Effects of β-Blockers With and Without Vasodilating Properties on Central Blood Pressure

“…Among the 15 parallel group studies, 7 studies [17][18][19]21,22,24,26 compared VBB with NVBB (n=186 for nonvasodilating β-blockers, n=209 for VBB); 2 studies 49,50 compared each 2 NVBB (atenolol versus bisoprolol); in 5 trials, β-blockers (3 NVBB 51-53 and 2 VBB 40,54 ) were compared against other antihypertensive classes; and in 1 case, a NVBB was tested against placebo. 55 Other antihypertensive drug classes were concomitantly administered in 5 studies (amlodipine, 51 hydrochlorothiazide, 23,53 lisinopril, 46 and lisinopril or losartan 22 ), whereas an add-on treatment approach with prespecified or unspecified other antihypertensive drug classes was allowed in 7 cases. 18,19,24,46,[52][53][54] In 9 studies, 18,20,23,47,48,[54][55][56] 19,21,22,24,50,51,53 ; and 1 study 26 did not report information about blindness of treatment.…”