A randomized multicenter study on ambulatory blood pressure and arterial stiffness in patients treated with valsartan/amlodipine or nifedipine GITS

Abstract

In a pre-specified subgroup analysis of a 12-week randomized multicenter study, we investigated effects of valsartan/amlodipine 80/5 mg single-pill combination (n = 75) and nifedipine GITS 30 mg (n = 75) on ambulatory blood pressure (BP) and arterial stiffness assessed by brachial-ankle pulse wave velocity (PWV) in patients with un-

Low‐dose combination therapy to control sustained ambulatory hypertension—Basic principles and future directions

“…Combination therapy with valsartan/amlodipine exerted a more potent BP‐lowering action during night‐time than during day‐time. In subgroup analysis stratified according to the dipping status, combination therapy was superior to monotherapy in lowering night‐time BP in non‐dippers, but not in dippers . When the analysis was stratified according to the ambulatory BP control status of participants at baseline, the BP‐lowering effect of combination therapy was similar to that of monotherapy in the subgroup of white‐coat uncontrolled hypertension.…”

“…According to the inclusion/exclusion criteria, this sub‐analysis enrolled 150 hypertensives with uncontrolled office BP, despite the administration of monotherapy for at least 4 weeks prior to study enrollment. Over a‐12‐week‐long follow‐up, in the overall population, valsartan/amlodipine combination was not superior to monotherapy with nifedipine GITS in lowering 24‐hour ambulatory BP (between‐group difference: −2.1/‐1.7 mm Hg, P > 0.20) . Combination therapy with valsartan/amlodipine exerted a more potent BP‐lowering action during night‐time than during day‐time.…”

“…In this issue of the Journal of Clinical Hypertension , Xu et al report the results of a prespecified sub‐analysis of an open‐label, randomized, controlled trial comparing the effect of low‐dose, single‐pill combination of valsartan/amlodipine (80/5 mg/day) versus nifedipine GITS (30 mg/day) on ambulatory BP and arterial stiffness. According to the inclusion/exclusion criteria, this sub‐analysis enrolled 150 hypertensives with uncontrolled office BP, despite the administration of monotherapy for at least 4 weeks prior to study enrollment.…”

“…By contrast, in those with sustained uncontrolled hypertension, combination therapy lowered more effectively 24‐hour ambulatory BP relative to monotherapy (between‐group difference: −4.9/‐3.8 mm Hg, P < 0.05). Valsartan/amlodipine combination therapy was also associated with improvement in arterial stiffness, assessed by measuring brachial‐ankle pulse wave velocity (PWV) …”

What is new in the 2018 Chinese hypertension guideline and the implication for the management of hypertension in Asia?

“…The new Chinese hypertension guidelines recommends the use of long‐acting antihypertensive drugs, often in combination and full dosages . There is growing evidence that long‐acting agents, especially in combination and full dosages, are more efficacious in reducing blood pressure and controlling hypertension . However, the guideline keeps recommending initial combination therapy only in stage 2 or more severe hypertension or those at high cardiovascular risk in whom a stringent therapeutic target of treatment is considered.…”