A Review of the Efficacy and Tolerability of Combination Amlodipine/Valsartan in Non-White Patients with Hypertension

Abstract

This article discusses racial/ethnic disparities in hypertension, with particular focus on non-white populations including blacks, Hispanics/Latinos, and Asians. Hypertension and its related morbidity and mortality affect a disproportionate number of black patients compared with white patients. Blacks, Hispanics/Latinos, and Asians have poor rates of hypertension awareness, treatment, and control. Given the high prevalence of comorbidities (e.g., obesity, diabetes, and metabolic syndrome) in these populations, renin–angiotensin–aldosterone system blockers are a good choice for foundation therapy. This review also discusses the importance of adherence and persistence with antihypertensive medication, which remain suboptimal in these non-white populations. Evidence suggests improvement with the use of single-pill combination therapy. Lastly, clinical trial data on the antihypertensive efficacy and safety of the combination of a dihydropyridine calcium channel blocker and an angiotensin receptor blocker, a widely utilized combination, in non-white populations are presented. PubMed was searched using the title/abstract key words (amlodipine AND valsartan AND [hypertension OR hypertensive] AND [black(s) OR African American(s) OR Hispanic(s) OR Latino(s) OR Mexican(s) OR Asian(s)]). In total, eight studies in patients with stage 1 or 2 hypertension were identified (n = 1,111 black, n = 389 Hispanic/Latino, and n = 3,094 Asian). Results showed that treatment with the combination of amlodipine plus valsartan is a reasonable choice for initial therapy or in patients who fail to respond to monotherapy. These drug classes have complementary mechanisms of action and, when used concomitantly, the magnitude of blood pressure lowering in these non-white populations is generally comparable with that seen in non-Hispanic white patients.

Polypharmacy in Older Adults With Hypertension: A Comprehensive Review

“…A meta‐analysis of about 40,000 patients with hypertension showed that a single‐pill combination regimen was associated with improved adherence, persistence, and lower all‐cause healthcare cost when compared with a free equivalent regimen . In patients with hypertension, using a single‐pill combination significantly reduces BP, reduces side effects, improves adherence, reduces healthcare cost, and potentially improves CV outcomes …”

“…82 In patients with hypertension, using a single-pill combination significantly reduces BP, reduces side effects, improves adherence, reduces healthcare cost, and potentially improves CV outcomes. 72,83,84 Technologies to Improve Adherence Ingestible Sensor System. Nonadherence may respond to innovative approaches such as utilizing an Ingestible Sensor System (ISS), a direct and reliable method of identifying drug use.…”

Tolerability of Antihypertensive Medications in Older Adults

“…Combination therapy may lower pill burden and improve adherence and clinical outcomes in some cases, without an increase in costs [170]; acceptability to therapy may be high, but discontinuation of medications, nevertheless, still occurs [171]. Combination therapy may also help synergistic enhancement of drug effects and reduction in adverse effects, with positive influence on safety and tolerability [104,172,173]. Triple fixed-dose combination therapy with an ARB, a CCB, and a thiazide favorably impact BP control [174].…”

Antihypertensive drug Valsartan promotes dendritic spine density by altering AMPA receptor trafficking

“…Hypertension is the abnormal state of high blood pressure, and it is one of the most common risk factors for cardiovascular disease [1]. Although the pathogenesis of this disorder is not yet fully understood, it is known that the renin-angiotensin system (RAS) has a key role in regulating blood pressure, and that irregular activation of RAS leads to hypertension and cardiovascular morbidity [2].…”