Use of ambulatory blood pressure monitoring to compare antihypertensive efficacy and safety of two angiotensin II receptor antagonists, losartan and valsartan |
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Authors: | Victor H Monterroso MD Victor Rodriguez Chavez MD Evert T Carbajal Daniel R Vogel MD Gustavo J Aroca Martinez MD Luis H Garcia MD Jorge H B Cuevas MD Joffre LaraTeran MD Gerhart Hitzenberger MD Pedro Leao Neves MD Shirley J Middlemost MD Thomas Dumortier Antonius M G Bunt MD Ronald D Smith PhD for the Losartan Trial Investigators |
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Institution: | (1) Hospital San Juan de Dios, Ciudad, Guatemala;(2) Clinica Maison de Sante, Hospital FAP Comandante J. B. Doric, Lima, Peru;(3) Hospital Regional Espanol, Buenos Aires, Argentina;(4) Clinica Renal de la Costa, Barranquilla, Colombia;(5) Hosital Universitario San Jorge, Pereira, Colombia;(6) Morones Prieto, Monterrey, Mexico;(7) Panamerican Clinic, Guayaquil, Ecuador;(8) Society for Clinical Pharmacology, Vienna, Austria;(9) Hospital de Faro, Faro, Portugal;(10) Johannesburg General Hospital, Parktown, South Africa;(11) MSD-CBARDS, Brussels, Belgium;(12) Merck & Co., Inc., One Merck Drive, PO Box 100 WS3C-50, 08889-0100 Whitehouse Station, NJ, USA |
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Abstract: | The efficacy and safety of Iosartan and valsartan were evaluated in a multicenter, double-blind, randomized trial in patients
with mild to moderate essential hypertension. Blood pressure responses to once-daily treatment with either losartan 50 mg
(n = 93) or valsartan 80 mg (n = 94) for 6 weeks were assessed through measurements taken in the clinic and by 24-hour ambulatory
blood pressure monitoring (ABPM). Both drugs significantly reduced clinic sitting systolic (SiSBP) and diastolic blood pressure
(SiDBP) at 2, 4, and 6 weeks. Maximum reductions from baseline in SiSBP and SiDBP on 24hour ABPM were also significant with
the two treatments. The reduction in blood pressure was more consistent across patients in the losartan group, as indicated
by a numerically smaller variability in change from baseline on all ABPM measures, which achieved significance at peak (P = .017) and during the day (P = .002). In addition, the numerically larger smoothness index with losartan suggested a more homogeneous antihypertensive
effect throughout the 24-hour dosing interval. The anti hypertensive response rate was 54% with losartan and 46% with valsartan.
Three days after discontinuation of therapy, SiDBP remained below baseline in 73% of losartan and 63% of valsartan patients.
Both agents were generally well tolerated. Losartan, but not valsartan, significantly decreased serum uric acid an average
0.4 mg/dL at week 6. In conclusion, once-daily losartan 50 mg and valsartan 80 mg had similar anti hypertensive effects in
patients with mild to moderate essential hypertension. Losartan produced a more consistent blood pressure-lowering response
and significantly lowered uric acid, suggesting potentially meaningful differences between these two A II receptor antagonists. |
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Keywords: | angiotensin II antagonist uric acid valsartan losartan ambulatory blood pressure monitoring (ABPM) |
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