Losartan/hydrochlorothiazide combination versus high dose losartan in patients with morning hypertension - A prospective, randomized, open-labeled, parallel-group, multicenter trial -
Losartan/hydrochlorothiazide combination versus high dose losartan in patients with morning hypertension - A prospective, randomized, open-labeled, parallel-group, multicenter trial -
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氯沙坦/氢氯噻嗪联合治疗与高剂量氯沙坦治疗晨间高血压患者的比较——一项前瞻性、随机、开放标签、平行组、多中心试验——
DOI：
10.1038/hr.2012.27
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发表时间：
2012
影响因子：
5.4
通讯作者：
Imaizumi T
中科院分区：
文献类型：
--
作者：
Ueda T;Kai H;Imaizumi T
晨间高血压的治疗还没有建立起来。我们比较了氯沙坦/氢氯噻嗪(HCTZ)联合用药和大剂量氯沙坦对晨间高血压患者的疗效和安全性。这是一项前瞻性、随机、开放标签、平行分组、多中心试验，纳入216名接受家庭血压(BP)自我测量评估的门诊晨间高血压患者。患者随机分为氯沙坦50 mg和羟基喜树碱12.5 mg联合治疗(n=109)或大剂量氯沙坦100 mg治疗(n=107)，每组每天早上给药一次。主要疗效终点为治疗3个月后的晨间收缩压(SBP)水平和目标血压达标率。在基线时，两个治疗组的血压水平相似。联合用药组晨间收缩压由150.3±10.1降至131.5±11.5 mm Hg(P<；0.001)，大剂量组由151.0±9.3降至142.5±13.6 mm Hg(P<；0.001)。联合治疗组晨间收缩压下降幅度大于大剂量治疗组(P<；0.001)。大剂量组夜间收缩压从138.9±9.9 mm Hg降至131.4±13.2 mm Hg(P<；0.001)。虽然两种疗法都提高了早晚目标血压达标率(P<；0.001)，但联合疗法比大剂量疗法提高的成功率更高(分别为P<；0.001和P<；0.05)。在临床测量中，联合治疗在降低收缩压和提高成功率方面优于大剂量治疗(P<；0.001和P<；0.01)。联合治疗可减少尿白蛋白排泄量(P<；0.05)，而大剂量治疗可降低血尿酸。两种疗法都显示出很强的依从性和很少的不良反应(P<；0.001)。结论：氯沙坦/羟基喜树碱联合治疗较大剂量氯沙坦能更有效地控制晨间高血压，降低尿白蛋白。
The treatment of morning hypertension has not been established. We compared the efficacy and safety of a losartan/hydrochlorothiazide (HCTZ) combination and high-dose losartan in patients with morning hypertension. A prospective, randomized, open-labeled, parallel-group, multicenter trial enrolled 216 treated outpatients with morning hypertension evaluated by home blood pressure (BP) self-measurement. Patients were randomly assigned to receive a combination therapy of 50 mg losartan and 12.5 mg HCTZ (n= 109) or a high-dose therapy with 100 mg losartan (n= 107), each of which were administered once every morning. Primary efficacy end points were morning systolic BP (SBP) level and target BP achievement rate after 3 months of treatment. At baseline, BP levels were similar between the two therapy groups. Morning SBP was reduced from 150.3±10.1 to 131.5±11.5 mm Hg by combination therapy (P< 0.001) and from 151.0±9.3 to 142.5±13.6 mm Hg by high-dose therapy (P< 0.001). The morning SBP reduction was greater in the combination therapy group than in the high-dose therapy group (P< 0.001). Combination therapy decreased evening SBP from 141.6±13.3 to 125.3±13.1 mm Hg (P< 0.001), and high-dose therapy decreased evening SBP from 138.9±9.9 to 131.4±13.2 mm Hg (P< 0.01). Although both therapies improved target BP achievement rates in the morning and evening (P< 0.001 for both), combination therapy increased the achievement rates more than high-dose therapy (P< 0.001 and P< 0.05, respectively). In clinic measurements, combination therapy was superior to high-dose therapy in reducing SBP and improving the achievement rate (P< 0.001 and P< 0.01, respectively). Combination therapy decreased urine albumin excretion (P< 0.05) whereas high-dose therapy reduced serum uric acid. Both therapies indicated strong adherence and few adverse effects (P< 0.001). In conclusion, losartan/HCTZ combination therapy was more effective for controlling morning hypertension and reducing urine albumin than high-dose losartan.