Prospective and randomized study of the antihypertensive effect and tolerability of three antihypertensive agents, losartan, amlodipine, and lisinopril, in hypertensive patients

Abstract

We prospectively evaluated the antihypertensive effect and tolerability of three different antihypertensive agents, losartan (angiotensin II receptor blocker), amlodipine (calcium channel blocker), and lisinopril (angiotensin-coverting enzyme inhibitor), in patients with mild-to-moderate hypertension. After a 2-week washout period, 121 patients were randomly allocated to three different groups for 12 weeks. Medications were titrated upward as necessary to achieve the goal office-recorded sitting diastolic blood pressure (SiDBP) (defined as SiDBP <90 mmHg or SiDBP > or = 900 mmHg but with a > or = 10 mmHg drop from baseline). Efficacy and tolerability were assessed after 4, 8, and 12 weeks of therapy with each regimen. At 12 weeks, significant differences in SiDBP compared with data of baseline were noted in all three groups ( P < 0.001 in all comparisons). Similarly, significant differences in the sitting systolic blood pressure compared with baseline data were also seen for all three groups ( P < 0.001 in all comparisons). The number of patients reaching goal SiDBP were comparable for the three groups: 25 patients (62.5%) in the losartan group, 27 patients (67.5%) in the amlodipine group, and 22 patients (59.5%) in the lisinopril group (not significant). Amlodipine produced a more pronounced reduction in SiDBP than the other two medications, although without statistical significance. Patients receiving lisinopril showed a high incidence of coughing (31.7%). Low leg edema was noted only in the amlodipine group (7.5%). Compared with the amlodipine and lisinopril groups, the losartan group seemed to have relatively fewer episodes (7.5%), and fewer patients (three cases) experienced adverse effects. In conclusion, this study demonstrates that losartan has the same antihypertensive effect, but has superior tolerability compared with the other two drugs. Coughing was a common side effect of lisinopril therapy in our population.

Persistence, Adherence, and Risk of Discontinuation Associated with Commonly Prescribed Antihypertensive Drug Monotherapies

“…21 Examining comparative persistence, adherence, and discontinuation rates within real-world settings, the current analyses are consistent with clinical trial findings that ARBs are associated with the fewest adverse effects among the most commonly utilized antihypertensive drug classes. 12,17,39,40 In addition to the potential for improved cardiovascular and renal outcomes, persistence or continuous use of antihypertensive therapy has been associated with lower overall health care costs. 30 The data in the current study differ somewhat from those used in other reports.…”

The Phase III, double-blind, parallel-group controlled study of amlodipine 10 mg once daily in Japanese patients with essential hypertension who insufficiently responded to amlodipine 5 mg once daily

“…In a variety of studies in Asian populations; furthermore, amlodipine 5 to 10 mg once daily has provided a sufficient antihypertensive effect on and good tolerability for hypertensive patients. [6][7][8][9][10][11][12][13][14] In addition, PRAISE, 15 Abbreviations: CI, confidence interval; DBP, diastolic blood pressure; N: number of subjects evaluated; SBP, systolic blood pressure. Baseline: Onset of the double-blind period (visit 5).…”

Renal Angiotensin II Type-2 Receptors Are Upregulated and Mediate the Candesartan-Induced Natriuresis/Diuresis in Obese Zucker Rats

“…10 The use of selective AT 1 receptor antagonists leads to reduction in blood pressure in human as well as in experimental animal models, including obese Zucker rats. 5,10,20,21 The greater reduction in blood pressure and greater natriuresis in the absence of enhanced renin activity in the plasma or the kidney of obese Zucker rats 10,22 may be attributed to increased activity of the AT 1 receptors. However, there has been a growing interest to understand the role of the AT 2 receptors, which are known to counteract the effects of the AT 1 receptors, in the renal cardiovascular regulation.…”