Efficacy of Initiating Therapy with Amlodipine and Hydrochlorothiazide or Their Combination in Hypertensive Nigerians

Iyalomhe, Godfrey B. S.; Omogbai, Eric K. I.; Isah, Ambrose O.; Iyalomhe, Osigbemhe; Dada, Folorunso L.; Iyalomhe, Sarah I.

doi:10.3109/10641963.2013.776570

Cited by 8 publications

(13 citation statements)

References 40 publications

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“…Although combination therapy showed a trend towards superiority with SBP/DBP (− 8.66; 95% CI − 18.72, 1.40/− 6.11; 95% CI − 9.15/− 3.07), the majority of this effect was from a small study of 31 participants comparing methyldopa with a beta-blocker and diuretic combination [33]. There was only 1 study which compared CCB monotherapy with combination therapy; here, perindopril plus hydrochlorothiazide was equally efficacious as high dose amlodipine (SBP − 1.65 mmHg in favour of ACEi + diuretic, 95% CI − 8.96, 5.66) [26].…”

Section: Combination Therapymentioning

confidence: 99%

Pharmacotherapy for hypertension in Sub-Saharan Africa: a systematic review and network meta-analysis

Seeley

Prynn

Perera

et al. 2020

BMC Med

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Background: The highest burden of hypertension is found in Sub-Saharan Africa (SSA) with a threefold greater mortality from stroke and other associated diseases. Ethnicity is known to influence the response to antihypertensives, especially in black populations living in North America and Europe. We sought to outline the impact of all commonly used pharmacological agents on both blood pressure reduction and cardiovascular morbidity and mortality in SSA. Methods: We used similar criteria to previous large meta-analyses of blood pressure agents but restricted results to populations in SSA. Quality of evidence was assessed using a risk of bias tool. Network meta-analysis with random effects was used to compare the effects across interventions and meta-regression to explore participant heterogeneity.Results: Thirty-two studies of 2860 participants were identified. Most were small studies from single, urban centres. Compared with placebo, any pharmacotherapy lowered SBP/DBP by 8.51/8.04 mmHg, and calcium channel blockers (CCBs) were the most efficacious first-line agent with 18.46/11.6 mmHg reduction. Fewer studies assessing combination therapy were available, but there was a trend towards superiority for CCBs plus ACE inhibitors or diuretics compared to other combinations. No studies examined the effect of antihypertensive therapy on morbidity or mortality outcomes.Conclusion: Evidence broadly supports current guidelines and provides a clear rationale for promoting CCBs as first-line agents and early initiation of combination therapy. However, there is a clear requirement for more evidence to provide a nuanced understanding of stroke and other cardiovascular disease prevention amongst diverse populations on the continent.

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Section: Combination Therapymentioning

confidence: 99%

Pharmacotherapy for hypertension in Sub-Saharan Africa: a systematic review and network meta-analysis

Seeley

Prynn

Perera

et al. 2020

BMC Med

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“…In particular and in contrast with some other reports (16)(17), it is remarkable that no patient in the AML group developed pedal edema. This may be explained by the fact that the patients were salt-sensitive and had adequate natriuresis and diuresis (2,5,(10)(11)(12)(13).…”

Section: Discussionmentioning

confidence: 99%

Adverse Events Profiles during Initiation of Treatment with Amlodipine or Hydrochlorothiazide in Type 2 Diabetic Nigerians with Essential Hypertension

Iyalomhe¹

2014

AJIM

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Background: Although, amlodipine (AML) and hydrochlorothiazide (HCZ) are recommended to initiate therapy in hypertensive patients, it has not been properly evaluated whether AML or HCZ would demonstrate a better adverse events profile. Objective: To determine whether AML or HCZ would be preferable to initiate antihypertensive treatment in type 2 diabetic Nigerians by comparing the adverse events profiles of the 2 drugs. Methods: Forty male (M) and female (F) newly diagnosed hypertensive subjects with controlled type 2 diabetic mellitus (T2DM) aged 43-68 years were randomized to AML and HCZ treatment groups of 20 patients each (10 Ms, 10 Fs), and they were treated respectively, with AML 10mg and HCZ 25mg, both drugs being given once daily for 48 weeks. Body mass index (BMI) was calculated for each subject. Blood pressure (BP), heart rate (HR), 24h urine volume were assessed at baseline and at the end of weeks 1, 3, 6, 12, 24, 36, and 48. Adverse events profiles were also recorded from week 1 through 48. Results: The drugs significantly reduced BP, though the effect of AML was significantly greater compared to that of HCZ (P<0.01). Diuresis was significant in HCZ group (P<0.01). There were 48 adverse events (48.5%) in the AML group including weight loss and mild tachycardia. No patient had peripheral pedal edema. Fifty one events (51.5%) occurred in HCZ group, weight loss, mild tachycardia, polyuria and myalgia/cramps being the commonest as well as impotence and visual disturbance. Conclusion: Though the two drugs appeared to be well tolerated, AML demonstrated a better BP-lowering effect and adverse events profile. Drugs that ensure adequate BP control and have the lowest possible risk for adverse events like AML, should be preferably used in diabetic Nigerian patients with essential hypertension.

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“… 5 , 6 Amlodipine and HCTZ are commonly prescribed in Nigeria as monotherapy and in combination with other antihypertensive drugs. 7 Amlodipine monotherapy was reported to have achieved similar reduction in blood pressure in elderly patients as a combination therapy with HCTZ. 8 Similarly, a previous study among Nigerians with essential hypertension showed that amlodipine was a more effective than HCTZ in reducing blood pressure.…”

Section: Introductionmentioning

confidence: 99%

Monotherapy with amlodipine or hydrochlorothiazide in patients with mild to moderate hypertension: Comparison of their efficacy and effects on electrolytes

Nwachukwu¹,

Eze²,

Nwachukwu³

et al. 2017

Mal. Med. J

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Background Amlodipine and hydrochlorothiazide (HCTZ) are commonly prescribed in Nigeria either as a monotherapy or in combination with other drugs. The present study was designed to investigate the antihypertensive efficacy of monotherapy with amlodipine or HCTZ and their effects on electrolyte profile in patients with mild to moderate hypertension. Methods A single-blind randomized clinical study was used; fifty patients newly diagnosed with mild to moderate hypertension (aged 33 to 60 years) were recruited and divided into two groups: amlodipine or hydrochlorothiazide each comprising of 25 subjects. The subjects received 5mg of amlodipine or 25mg of hydrochlorothiazide in their respective group once daily for 4 weeks. Blood pressure, serum and urine electrolytes were measured at baseline and weekly throughout the experiment. Results At the end of follow up, amlodipine reduced systolic and diastolic blood pressure significantly more (p<0.001) than HCTZ. At the end of follow up, blood pressure was reduced to normal in 80% of the subjects in amlodipine group compared to 50% in HCTZ. Amlodipine had no significant effect on electrolyte profile of subjects unlike HCTZ which significantly changed both their serum and urine electrolytes. Conclusions Monotherapy with amlodipine was more effective than HCTZ in black patients with mild to moderate hypertension and in addition maintained electrolyte balance.

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Efficacy of Initiating Therapy with Amlodipine and Hydrochlorothiazide or Their Combination in Hypertensive Nigerians

Cited by 8 publications

References 40 publications

Pharmacotherapy for hypertension in Sub-Saharan Africa: a systematic review and network meta-analysis

Pharmacotherapy for hypertension in Sub-Saharan Africa: a systematic review and network meta-analysis

Adverse Events Profiles during Initiation of Treatment with Amlodipine or Hydrochlorothiazide in Type 2 Diabetic Nigerians with Essential Hypertension

Monotherapy with amlodipine or hydrochlorothiazide in patients with mild to moderate hypertension: Comparison of their efficacy and effects on electrolytes

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