24-HOUR CENTRAL BLOOD PRESSURE REDUCTION EFFICACY OF CALCIUM CHANNEL BLOCKER COMBINATION IS SUPERIOR TO DIURETICS COMBINATION WITH ANGIOTENSIN II RECEPTOR BLOCKER ESPECIALLY IN MALE HYPERTENSIVE PATIENTS

초록

Background: The aim of this study was to compare 24-hour central blood pressure (24 hr c-BP) reduction efficacy between angiotensin II receptor blocker (ARB) combined with calcium channel blocker and with diuretics. Methods: We conducted a prospective, randomized, double-blind trial in 220 hypertensive patients [mean age = 59.6 ± 12.3 years, men = 154(70%)]. Patients received losartan 50 mg monotherapy for 4 weeks, followed by additional use of amlodipine 5 mg (L/A group) or hydrochlorothiazide 12.5 mg (L/H group) for 20 weeks. The patients without achievement of BP goal after 4 weeks randomization were increased dose to 100 mg/5 mg (L/A group) and 100 mg/25 mg (L/H group) respectively. 24 hr ambulatory c-BP was measured at baseline and after 20 weeks treatment. Results: The 24 hr mean systolic c-Systolic BP was significantly lower in L/A group than L/H group especially in male hypertensive patients. The office BP showed no significant differences between two groups in male hypertensives. However, the 24 hr mean systolic c-BP of female hypertensives showed no significant differences even with significant greater office BP reduction in L/A groups. (Table) Conclusion: These data showed that the combination of losartan and amlodipine had a more beneficial effect on 24 hr c-Systolic BP than the combination of losartan and hydrochlorothiazide in men hypertensives regardless of office BP reduction efficacy. This gender specific 24 hr c-Systolic BP reduction efficacy needs to be evaluated.