卡托普利与螺内酯联合治疗高血压病伴心力衰竭60例分析

目的观察血管紧张素转换酶抑制剂卡托普利与螺内酯联合治疗高血压性心力衰竭的疗效和安全性。方法选60例高血压性心力衰竭患者,给予口服卡托普利5~10 mg,3次/d,螺内酯20~40 mg,1次/d,观察血压和心功能的改善情况。结果全部患者降压有效率为90.0%;心功能改善情况总有效率93.3%,其中显效70.0%,有效23.3%,无严重不良反应。结论卡托普利与螺内酯联合治疗高血压伴心力衰竭有效。     

氢氯噻嗪对高血压患者血清高敏C-反应蛋白浓度的影响

目的研究高血压患者服用氢氯噻嗪（HCTZ）后血清高敏C-反应蛋白（hsCRP）浓度的变化。方法732例高血压患者同时服用氢氯噻嗪12．5mg，1；L／d。6周后，比较资料完整的715例患者治疗前后血清hsCRP浓度的变化。并按患者的降压疗效分组比较不同降压反应对hsCRP浓度的影响。结果715例患者治疗前后血清hsCRP浓度分别为2．39和2．10mg／L，治疗后血清hsCRP浓度低于治疗前（P〈0．05）。治疗后血压达标组血清hsCRP浓度低于非达标组（P〈0．05）；治疗前后不同收缩压水平患者血清hsCRP浓度不同（P〈0．05）。血清hsCRP水平与治疗前后收缩压水平均呈正相关（r=0．10，r=0．12，P〈0．05）。多元线性回归结果表明体质指数、治疗后收缩压水平、年龄影响患者治疗后血清hsCRP浓度。结论高血压患者服用氢氯噻嗪后血清hsCRP浓度下降；收缩压水平是影响血清hsCRP水平的主要因素。     

卡托普利联合螺内酯治疗心功能不全在基层医院的应用

目的 观察卡托普利联合螺内酯在基层医院治疗心功能不全中的作用。方法 将42例心功能不全患者随机分为治疗组22例，对照组20例。对照组给予常规治疗，治疗组在常规治疗的基础上，加用卡托普利12.5～25mg，3次/d，螺内酯25mg，1次/d。结果 两组治疗后心功能较治疗前均有改善，治疗组与对照组的总有效率分别为90.91％，70％。结论 卡托普利和螺内酯的联合应用可发挥协同作用，增强疗效，可作为基层医院治疗心功能不全患者的长期理想用药。     

氢氯噻嗪和卡托普利对原发性高血压患者CYP11B2基因多态性和血浆醛固酮浓度的影响

目的探讨CYP11B2(-344C/T)基因多态性与原发性高血压患者血浆醛固酮(ALD)浓度的关系及氢氯噻嗪(HCTZ)和卡托普利对血浆ALD浓度的影响。方法应用PCR技术检测240例原发性高血压患者CYP11B2基因型同时测定其血浆ALD浓度,然后均服用6周HCTZ,12.5mg/d,6周后加用卡托普利25mg,2次/d,随访1年。1年末所余资料完整的219例患者按TT、TC、CC基因型分为3组,比较3组不同基因型患者血浆ALD浓度的变化。结果服药前3组患者血浆ALD浓度无差别,6周后,3组患者血浆ALD水平均较服药前有所增高,TT、TC2组ALD水平与服药前比较差异有显著性;加用卡托普利继续治疗1年后,3组患者血浆ALD水平又都有不同程度的回降,其中TC组ALD水平与服药前比较差异有显著性(P<0.05)。3组患者血浆ALD浓度下降值比较差异无显著性。结论服用HCTZ后CC组血浆ALD浓度上升幅度小于其他2组,加用卡托普利后3组患者血浆ALD浓度均有所回降,CC基因型患者的下降幅度高于其他2组。     

一清胶囊联合螺内酯治疗青春后痤疮疗效分析

目的 观察一清胶囊联合螺内酯治疗青春后痤疮临床疗效.方法 将84例痤疮患者随机分成2组,治疗组口服一清胶囊(成都康弘制药有限公司)1.0g,3次/d,螺内酯20 mg,3次/d,局部外用氯霉素水杨酸酊(医院自制),2次/d.对照组口服米诺环素50 mg,2次/d,螺内酯20 mg,3次/d,外用药物同治疗组.两组疗程均为6周,患者每2周复诊1次,观察疗效及不良反应.结果 治疗组有效率为61.9％,对照组有效率为59.5％,两组间治疗有效率差异无统计学意义(x2=0.05,P=0.823 ＞0.05).结论 一清胶囊联合螺内酯治疗青春后痤疮安全有效,不良反应轻微.     

口服螺内酯致男性乳房发育症误诊1例分析

对我院2005-2008年口服螺内酯致男性乳房发育症误诊误治1例分析如下。1病历摘要男,69岁。高血压病史15 a,血压最高170/90 mm Hg,长期口服依那普利10 mg,2次/d,硝苯地平缓释片10 mg,2次/d,血压控制在140/80 mm Hg左右。近1 a来出现高血压性心肌肥大,心功能不全,当地医院即加用利尿剂氢氯噻嗪25 mg,1次/d,螺内酯40 mg,1次/d。口服螺内酯0.5 a后无意间发     

卡托普利与氨氯地平联合治疗高血压合并糖尿病的疗效观察

目的 观察卡托普利与氨氯地平联合治疗高血压合并糖尿病的疗效.方法 选择高血压合并糖尿病患者80例,随机分为2组,卡托普利组40例,给予卡托普利12.5 mg口服,联合治疗组40例,在卡托普利组治疗基础上加用氨氯地平2.5 mg,均治疗4周,治疗前后检测收缩压、舒张压、空腹血糖,并对比分析治疗前后上述指标差异.结果 治疗4周后2组血压均下降,卡托普利组收缩压为(141±10)mm Hg,舒张压为(88±5)mm Hg,组内自身治疗前后比较均有统计学意义(P<0.01),联合治疗组降压幅度高于卡托普利组,与治疗前后比较差异有统计学意义(P<0.01).结论 卡托普利与氨氯地平联合应用降压疗效更好.     

螺内酯对老年心房颤动患者血清Ⅰ型胶原代谢的影响

目的 通过测定老年心房颤动(房颤)患者使用螺内酯治疗前后血清醛固酮、Ⅰ型前胶原羧基端肽(PICP)及Ⅰ型胶原羧基端交联肽(CITP)水平的变化,探讨螺内酯减轻心房纤维化的可能机制.方法 选择房颤患者67例和条件相匹配的窦性心律患者30例,并将房颤患者随机分为常规治疗组(33例)及螺内酯(20mg/d)治疗组(34例),治疗6个月,用放射免疫法测定治疗前后血清醛固酮、PICP及CITP水平.另选对照组为30例,无房颤发作史,心电图及24小时动态心电图为窦性心律,一般资料匹配.结果 房颤组血清PICP、CITP、醛固酮浓度及左房大小均显著高于对照组(P＜0.01).房颤组血清醛固酮与左房大小呈正相关( r=0.302,P＜0.05)、血清PICP浓度与左房大小呈正相关( r=0.369,P＜0.01),螺内酯治疗组与常规治疗组治疗后血清醛固酮、PICP水平与治疗前相比均下降,但螺内酯治疗组下降更明显,治疗后两组血清醛固酮及PICP水平比较差异具有统计学意义(P＜0.01).结论 螺内酯通过降低房颤患者血清醛固酮、PICP水平,从而减轻心房纤维化,延缓房颤的发生发展.     

坎地沙坦与螺内酯联合治疗慢性心力衰竭疗效观察

目的:观察坎地沙坦与螺内酯联用对于慢性心力衰竭的疗效。方法:将2005年5月—2006年8月本院符合美国心脏病学会诊断标准的慢性心力衰竭118例患者,随机分成两组,治疗组用坎地沙坦4～8mg,1次/d,并用螺内酯20mg,2次/d,口服;对照组采用基础治疗 螺内酯20mg,2次/d,口服。连续服用6个月,记录症状、体征及其作用,超声心动图改变及肝肾功能情况。结果:治疗组心力衰竭程度显著改善。结论:坎地沙坦与螺内酯联用能显著改善慢性心力衰竭,临床效果好。     

联合降压调脂在社区治疗老年人高血压合并高脂血症中的效果观察

【目的】观察氢氯噻嗪联合卡托普利,加用辛伐他汀在社区治疗老年人高血压病合并高脂血症的效果。【方法】将209例老年高血压合并高脂血症患者随机分为两组,治疗组117例,对照组92例。治疗组给予氢氯噻嗪6.25~12.5mg/d,卡托普利75mg/d,辛伐他汀10~20mg/d,对照组仅给予氢氯噻嗪6.25~12.5mg/d,卡托普利75mg/d治疗,观察患者血压、血脂、12个月内心脑血管事件。【结果】两组患者血压均稳定下降,组间无显著性差异(P>0.05),但治疗组血脂各项指标有明显改善,心脑血管事件明显少于对照组(P<0.05)。【结论】在社区采取降压结合调脂治疗老年人高血压合并高脂血症患者,可明显减少心血管事件发生率,有利于提高患者的生活质量。     

Ambulatory monitoring of systolic hypertension in the elderly: Eprosartan/hydrochlorothiazide compared with losartan/hydrochlorothiazide (INSIST trial)

Introduction

Systolic hypertension is very common in the elderly and is strongly associated with the risk of cardiovascular and cerebrovascular events. The control of systolic hypertension is difficult and most patients require combination antihypertensive therapy. Few data are available regarding the efficacy of angiotensin II receptor antagonists on systolic hypertension of the elderly. The aim of this double-blind, double-dummy, randomized, parallel-group, multicenter study was to assess the efficacy of eprosartan 600 mg in combination with hydrochlorothiazide (HCTZ) 12.5 mg in comparison with losartan 50 mg in combination with HCTZ 12.5 mg, in reducing blood pressure in elderly patients with grade 2 systolic hypertension who did not optimally respond to eprosartan or losartan monotherapy.

Methods

After a 3-week placebo wash-out, 155 patients with an Office trough sitting systolic blood pressure (Office sitSBP) ≥160 mmHg and <180 mmHg were randomized to eprosartan 600 mg (n=78) or losartan 50 mg (n=77) once daily for 6 weeks. In patients not optimally responding to monotherapy (Office sitSBP≥130 mmHg) 12.5 mg HCTZ was added as fixed combination once daily for 6 weeks. A 24-hour ambulatory blood pressure monitoring (ABPM) was performed at the end of wash-out and at the end of the fixed-combination period.

Results

No statistically significant difference was found between eprosartan/HCTZ and losartan/HCTZ on the primary endpoint (24-hour ABPM SBP) with an adjusted mean difference between treatments of 3.1 mmHg (95% CI: ?0.32–6.59). However, the mean 24-hour ABPM SBP significantly decreased by 16.7 mmHg with eprosartan/HCTZ and 20.3 mmHg with losartan/HCTZ (P<0.001 vs. baseline). The mean Office sitSBP significantly decreased by 28.7 mmHg and 29.6 mmHg respectively, with eprosartan/HCTZ and losartan/HCTZ (P<0.001 vs.baseline and vs. monotherapy).

Conclusion

In this study, eprosartan/HCTZ did not demonstrate to be superior to losartan/HCTZ in reducing ABPM systolic hypertension in the elderly.     

Hydrochlorothiazide added to valsartan is more effective than when added to olmesartan in reducing blood pressure in moderately hypertensive patients inadequately controlled by monotherapy

This study was undertaken to evaluate the effects on blood pressure of hydrochlorothiazide (HCTZ) 12.5 mg added to valsartan 160 mg or to olmesartan 20 mg in hypertensive patients. After a 2-wk placebo period, 130 patients, aged 35 to 75 y, with diastolic blood pressure (DBP) ≥99 and <110 mm Hg were randomly assigned to olmesartan 20 mg once daily or to valsartan 160 mg once daily according to a prospective, parallel-arm study design. After 4 wk of monotherapy, patients whose BP was not controlled (DBP ≥90 mm Hg) were given combination treatment with HCTZ 12.5 mg for an additional 4 wk. At the end of the placebo period and at the end of each treatment period, clinical and ambulatory BP measurements were recorded. At the end of the combination therapy period, venous blood samples were drawn 2, 4, and 24 h after drug intake for evaluation of HCTZ plasma concentrations. Both combinations induced a greater ambulatory BP reduction than monotherapy. However, mean reduction from baseline in the valsartan/HCTZ-treated patients (-21.5/-14.6 mm Hg for 24 h, -21.8/-14.9 mm Hg for daytime, and -20.4/-13.7 mm Hg for nighttime systolic blood pressure [SBP]/DBP) was greater than in the olmesartan/HCTZ-treated patients (-18.8/-12.3 mm Hg for 24 h, -19.3/-12.8 mm Hg for daytime, and -17.4/-10.6 mm Hg for nighttime SBP/DBP). The difference between the effects of the 2 treatments was significant (P<.01). In particular, compared with monotherapy, the add-on effect of HCTZ 12.5 mg was significantly greater in the valsartan group than in those treated with olmesartan; the difference was more evident for nighttime BP values. Plasma concentrations of HCTZ were significantly greater with valsartan than with olmesartan at each determination time (P<.05). These findings suggest that the addition of HCTZ 12.5 mg to valsartan 160 mg monotherapy produces a greater BP reduction than the addition of the same dose of HCTZ to olmesartan 20 mg monotherapy.     

The effects of irbesartan added to hydrochlorothiazide for the treatment of hypertension in patients non-responsive to hydrochlorothiazide alone

AIM: To evaluate the antihypertensive efficacy and safety of adding irbesartan to hydrochloride (HCTZ) in patients not adequately controlled by HCTZ alone. PATIENTS AND METHODS: In this multicenter study, after a single-blind, placebo lead-in period, hypertensive patients received single-blind HCTZ 25 mg once daily. After 4 weeks, 238 patients with seated diastolic blood pressure of 93-110 mmHg continued on HCTZ 25 mg once daily and were randomized to double-blind irbesartan 75 mg once daily or matching placebo for 12 weeks. At week 6, the dosage of irbesartan or placebo was doubled for seated diastolic blood pressure > or = 90 mmHg. RESULTS: At weeks 2, 6, and 12, irbesartan/HCTZ resulted in significantly greater (P<0.01) reductions from baseline in trough seated diastolic and systolic blood pressure compared with placebo/HCTZ. At week 12, the mean reductions in trough seated diastolic and systolic blood pressure were 7.2 mmHg (95%, C.I., 5.1-9.3 mmHg) and 11.1 mmHg (95% C.I., 7.9-14.3 mmHg) greater, respectively, with irbesartan/HCTZ compared with placebo/HCTZ. At week 12, significantly (P < 0.01) more patients were normalized (trough seated diastolic blood pressure < 90 mmHg) with irbesartan/HCTZ (67%) compared with placebo/HCTZ (29%). The frequency of adverse events, serious adverse events, and discontinuations attributed to adverse events was similar in both groups, and there were no clinically relevant changes in serum creatinine, potassium, or any other laboratory parameter. CONCLUSION: Irbesartan was effective and well tolerated when added to a background of HCTZ 25 mg in patients whose blood pressure was not adequately controlled by HCTZ alone.     

Effects of valsartan/ hydrochlorothiazide and amlodipine on ambulatory blood pressure and plasma norepinephrine levels in high-risk hypertensive patients

The efficacy and tolerability of the combination of valsartan and hydrochlorothi-azide (HCTZ) were compared with that of amlodipine in reducing ambulatory blood pressure and plasma norepinephrine levels in patients with mild to moderate hypertension and at least 1 cardiovascular risk factor. At the end of a 2-week washout period, 92 outpatients with a sitting diastolic blood pressure ≥95 and <110 mm Hg, associated with at least 1 additional risk factor, were randomly assigned to receive either valsartan 160 mg and HCTZ 12.5 mg once daily (n=46) or amlodipine 10 mg alone once daily (n=46) for 12 weeks, according to a prospective, randomized, open-label, blinded end point, parallel-group design. At the end of the washout period and after 6 and 12 weeks of active treatment, 24-hour ambulatory blood pressure monitoring was performed, and clinical blood pressure and heart rate and plasma norepinephrine levels were assessed (by high-performance liquid chromatography). Both the valsartan/HCTZ combination and amlodipine had a demonstrable antihypertensive effect, but the combination showed an antihypertensive effect significantly greater than that of amlodipine, as demonstrated by the 24-hour (P < .001), daytime (P < .001), and nighttime ambulatory blood pressure values (P < .01) and by the clinical blood pressure values at trough, which were all significantly lower. Although the trough-to-peak ratios were similar in both groups, the smoothness indexes pertaining to both systolic and diastolic pressures were significantly higher (P < .05 andP < .001, respectively) in patients receiving valsartan/HCTZ, suggesting the combination produces a more homogeneous antihypertensive effect. A significant increase in plasma norepinephrine levels was associated with amlodipine (+9% at 6 weeks, +15% at 12 weeks) but not with the valsartan/HCTZ combination. The valsartan/HCTZ combination was better tolerated than amlodipine, which was associated with a higher frequency of ankle edema. These results indicate that the combination of valsartan 160 mg and HCTZ 12.5 mg provides more sustained and homogeneous control of blood pressure than does amlodipine 10 mg in high-risk hypertensive patients, without producing reflex sympathetic activation.     

Treatment of hypertension in the very old

The objective of this study was to compare the long-term efficacy and safety of 6 months' treatment with barnidipine and hydrochlorothiazide (HCTZ) as monotherapy in patients aged > or = 75 years with mild to moderate essential hypertension. This was a randomised, double-blind, dose-titration study performed at 62 centres in 8 countries. A total of 397 patients were enrolled. Following a 4 week single-blind placebo runin, 315 patients with a sitting diastolic blood pressure (SiDBP) of 95-115 mmHg and a systolic blood pressure of 150-200 mmHg were randomised to receive barnidipine 10 mg (n = 159) or HCTZ 12.5 mg (n = 155) once daily. In patients who had not responded (SiDBP > 90 mmHg) after 6 weeks of double-blind treatment, the dose was titrated upwards to barnidipine 20 mg or HCTZ 25 mg. After 18 weeks, those who did not respond to the higher dose had enalapril (up to 10 mg once daily) added to their regimen. Statistically equivalent reductions in SiDBP were achieved with barnidipine and HCTZ monotherapy. At week 18 of double-blind treatment on monotherapy, 84% of patients in both groups were responders. The addition of enalapril in non-responders produced a further reduction in blood pressure. Both drugs were well tolerated. The incidence of drug-related adverse events was greater in the barnidipine than HCTZ-treated group but they were consistent with vasodilation and were categorised as mild to moderate. In conclusion, barnidipine and HCTZ are well tolerated and have equivalent long-term antihypertensive efficacy in older hypertensive patients. For patients whose blood pressure is inadequately controlled on monotherapy, combination therapy with enalapril is effective.     

Efficacy and tolerability of enalapril (20 mg)/hydrochlorothiazide (12.5 mg) combination therapy in essential hypertension.

The efficacy and tolerability of a preconstituted formulation combining enalapril (20 mg) and hydrochlorothiazide (12.5 mg) were evaluated in patients with essential hypertension unresponsive to enalapril monotherapy (20 mg/day). The duration of this open-lable, multicenter, noncomparative trial was 12 weeks: a two-week washout period followed by ten weeks of active treatment. During the active treatment period, patients received enalapril alone (up to 20 mg/day) for six weeks. At the end of week 6, patients with supine diastolic blood pressure greater than 90 mmHg were treated with the enalapril/hydrochlorothiazide combination therapy (EN/HCTZ). Of the 147 patients who were entered into the study, 81 were not normalized with enalapril alone. At the end of the study period, blood pressure was normalized (supine diastolic blood pressure less than or equal to 90 mmHg) in 60 (74%) of the 81 patients who had received the EN/HCTZ combination. Overall, 86% of the patients achieved satisfactory blood pressure control with this therapeutic regimen. Adverse reactions were mild and transient. Six patients experienced undesirable effects, the most frequent of which was coughing (2 cases). Neither enalapril (20 mg/day) alone nor the EN/HCTZ combination had any significant influence on any of the metabolic parameters evaluated. No hypokalemia and no significant changes in serum lipids occurred in the course of the study.     

Hydrochlorothiazide and spironolactone in hypertension.

A double-blind study of hydrochlorothiazide and spironolactone, alone and in combination, was conducted in 49 patients with mild-to-moderate essential hypertension after a 4-wk placebo washout period. In the whole group mean arterial blood pressure fell to levels of less than or equal to 107 mm Hg or declined by more than 15 mm Hg in 78% of the patients after twelve weeks of treatment. Sixty-nine percent of patients receiving hydrochlorothiazide alone developed serum potassium levels lower than 3.5 mEq/L; serum potassium levels were above 5.5 mEq/L in 2 patients (5.5%) receiving spironolactone 400 mg/day. Uric acid levels rose in all patients, more in those on hydrochlorothiazide, but clinical gout did not develop in any subject. Hydrochlorothiazide, spironolactone, and the combination of the two are effective antihypertensives. Spironolactone in doses of 200 and 400 mg/day was associated with side effects but did not induce a greater antihypertensive effect than doses of 100 mg/day. Our data suggest that when hydrochlorothiazide is associated with potassium loss, when gout or elevated uric acid levels are of concern, or when carbohydrate tolerance is abnormal, supplementation or replacement with spironolactone (up to 100 mg/day) may be useful in controlling blood pressure while reducing side effects.     

Antihypertensive efficacy and tolerability of two fixed-dose combinations of valsartan and hydrochlorothiazide compared with valsartan monotherapy in patients with stage 2 or 3 systolic hypertension: an 8-week, randomized, double-blind, parallel-group trial

BACKGROUND: Combination therapy with at least 2 antihypertensive agents is usually needed to achieve appropriate blood pressure (BP) control in patients with isolated or predominant systolic hypertension. A currently recommended combination is a diuretic added to an angiotensin-receptor blocker. OBJECTIVE: This was a study of the effects on sitting systolic BP (SBP)of 2 combinations of valsartan and hydrochlorothiazide (HCTZ) compared with valsartan monotherapy in patients with stage 2 or 3 systolic hypertension (SBP > or =160 mm Hg and < or =200 mm Hg) with or without other cardiovascular risk factors. METHODS: After a placebo run-in period, patients were randomized to receive double-blind treatment with either valsartan 80 mg OD(monotherapy group) or valsartan 160 mg OD (combination-therapy groups) for 4 weeks, followed by forced titration to valsartan 160 mg OD (V160), valsartan 160 mg plus HCTZ 12.5 mg OD (V160 +HCTZ12.5), or valsartan 160 mg plus HCTZ 25 mg OD (V160 +HCTZ25) for an additional 4 weeks. End points were the change in SBP between the groups receiving combination therapy and the monotherapy group, between-group changes in diastolic BP (DBP), responder rates (SBP <140 mm Hg or a reduction in SBP of > or =20 mm Hg), and tolerability. RESULTS: A total of 774 patients were randomized to treatment: 261 to V160, 258 to V160+HCTZ12.5, and 255 to V160 +HCTZ25. The intent-to-treat population consisted of 767 patients (411 men, 356 women; mean age, 60 years; mean weight, 84 kg; clinic mean [SD] baseline BP, 167.5 [8.1]/93.4 [9.1] mm Hg). All treatments produced significant reductions in SBP from baseline (mean [SD] reduction, 20.7 [15.7] mm Hg with V160, 27.9 [13.8] mm Hg with V160 +HCTZ12.5, and 28.3 [13.1] mm Hg with V160+HCTZ25; all, P < 0.05). DBP was reduced by 6.6 (8.9) mm Hg in the V160 group and by 10.2 (7.7) and 10.1 (7.8) mm Hg in the V160+HCTZ12.5 and V160 +HCTZ25 groups, respectively (all, P < 0.05). The additional reductions in BP with V160+HCTZ25 did not reach statistical significance compared with V160+HCTZ12.5. Responder rates were 56.9% in the V160 group, 74.4% in the V160+HCTZ12.5 group, and 75.0% in the V160 +HCTZ25 group P < 0.05, combination therapy vs monotherapy). Adverse events were reported by 27.5% of patients in the monotherapy group, compared with 28.6% and 34.0% in the groups that received V160+HCTZ12.5 and V160+HCTZ25, respectively; the differences were not significant between treatment groups. CONCLUSIONS: Monotherapy with V160 was effective in these patients with stage 2 or 3 systolic hypertension. Significant additional reductions in SBP and DBP and an increase in responder rates were achieved with the addition to V160 of HCTZ12.5 and HCTZ25, with no significant effect on tolerability.     

Efficacy and tolerability of fixed-dose combinations of telmisartan plus HCTZ compared with losartan plus HCTZ in patients with essential hypertension

Telmisartan, an angiotensin II receptor blocker, is an effective once-daily antihypertensive agent available either alone or in fixed-dose combination with hydrochlorothiazide (HCTZ). This multicentre, prospective, randomised, open-label, blinded-endpoint (PROBE) study assessed the efficacy and safety of six weeks' treatment with telmisartan 40 mg/HCTZ 12.5 mg (n = 199) and telmisartan 80 mg/HCTZ 12.5 mg (n = 200) versus losartan 50 mg/HCTZ 12.5 mg (n = 198) in patients with mild to moderate essential hypertension. During the last six hours of the dosing interval, telmisartan 40 mg/HCTZ 12.5 mg and telmisartan 80 mg/HCTZ 12.5 mg reduced mean ambulatory diastolic blood pressure (DBP) to a greater extent than losartan 50 mg/HCTZ 12.5 mg (treatment differences 1.8 mmHg [p < 0.05] and 2.5 mmHg [p < 0.001], respectively). Telmisartan 80 mg/HCTZ 12.5 mg also lowered mean 24-hour DBP by 2.3 mmHg more than losartan 50 mg/HCTZ 12.5 mg (p < 0.001). Telmisartan 40 mg/HCTZ 12.5 mg and telmisartan 80 mg/HCTZ 12.5 mg produced greater reductions in ambulatory systolic blood pressure versus losartan 50 mg/HCTZ 12.5 mg of 2.5 mmHg and 3.4 mmHg, respectively, during the last six hours of the dosing interval (p < 0.05), and of 2.1 mmHg and 3.4 mmHg, respectively, over the entire 24-hour dosing interval (p < 0.05). All treatments were well tolerated.