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Comparative efficacy and safety profile of amlodipine 5 mg/losartan 50 mg fixed-dose combination and amlodipine 10 mg monotherapy in hypertensive patients who respond poorly to amlodipine 5 mg monotherapy: an 8-week, multicenter, randomized, double-blind phase III noninferiority study.

Authors
 Seok-Min Kang  ;  Jong-Chan Youn  ;  Shung Chull Chae  ;  Chang Gyu Park  ;  Joo Young Yang  ;  Moo Hyun Kim  ;  Taek Jong Hong  ;  Cheol Ho Kim  ;  Jae Joong Kim  ;  Dong Gu Shin  ;  Jin Won Jung  ;  Jung Han Yoon  ;  Si Hoon Park  ;  Jun Kwon  ;  Seung Yun Cho 
Citation
 CLINICAL THERAPEUTICS, Vol.33(12) : 1953-1963, 2011 
Journal Title
CLINICAL THERAPEUTICS
ISSN
 0149-2918 
Issue Date
2011
MeSH
Adult ; Amlodipine/administration & dosage* ; Amlodipine/adverse effects ; Analysis of Variance ; Angiotensin II Type 1 Receptor Blockers/administration & dosage* ; Angiotensin II Type 1 Receptor Blockers/adverse effects ; Antihypertensive Agents/administration & dosage* ; Antihypertensive Agents/adverse effects ; Blood Pressure/drug effects* ; Calcium Channel Blockers/administration & dosage* ; Calcium Channel Blockers/adverse effects ; Chi-Square Distribution ; Dose-Response Relationship, Drug ; Double-Blind Method ; Drug Combinations ; Female ; Humans ; Hypertension/diagnosis ; Hypertension/drug therapy* ; Hypertension/physiopathology ; Losartan/administration & dosage* ; Losartan/adverse effects ; Male ; Middle Aged ; Republic of Korea ; Time Factors ; Treatment Outcome
Keywords
amlodipine ; hypertension ; losartan
Abstract
BACKGROUND: The number of hypertensive patients achieving treatment targets is not ideal with therapies that engage a single mechanism of action, and combination therapies using different mechanisms of action can increase drug efficacy in a synergistic way.

OBJECTIVE: This noninferiority study compared the clinical efficacy and safety profile of fixed-dose combination of amlodipine/losartan 5/50 mg and amlodipine 10 mg monotherapy in essential hypertensive patients who respond poorly to amlodipine 5 mg monotherapy.

METHODS: This was a double-blind, multicenter, randomized trial of hypertensive patients (N = 185) aged ≥18 years taking amlodipine 5 mg during the run-in treatment period but failed to achieve sitting diastolic blood pressure (DBP) <90 mm Hg. After randomization into the amlodipine/losartan 5/50 mg fixed-dose combination group (n = 92) and the amlodipine 10 mg monotherapy group (n = 93), treatment was maintained without dose escalation for 8 weeks. The noninferiority margin was prespecified as 4 mm Hg after 8 weeks of treatment for the difference of the average change in DBP between treatments. The primary efficacy evaluation of noninferiority was tested using a confidence interval approach with a 97.5% 1-sided lower confidence limit using the average difference in DBP measured at baseline and 8 weeks.

RESULTS: After 8 weeks, the DBP of both groups decreased from baseline by 8.9 (6.1) and 9.4 (7.5) mm Hg, respectively (difference = -0.5 [6.9] mm Hg, 95% CI: -2.5 to 1.5). Secondary end points of reductions in DBP after 4 weeks (-8.1 [6.7] vs -9.9 [7.3] mm Hg, difference = -1.8 mm Hg, 95% CI: -3.9 to 0.2) and sitting systolic blood pressure after 4 (-10.2 [11.8] vs -12.8 [10.2] mm Hg, difference = -2.6 mm Hg, 95% CI: -5.9 to 0.6) and 8 weeks (-12.2 [11.0] vs -13.4 [11.3] mm Hg, difference = -1.2 mmHg, 95% CI: -4.4 to 2.1) were comparable between the 2 treatment groups. There were 38 adverse events in 20 patients (21.7%) in the amlodipine/losartan 5/50 mg fixed-dose combination group and 31 in 24 patients (26.1%) in the amlodipine 10 mg monotherapy group; most were mild. There were 7 adverse events in 6 patients (6.5%) related to treatment in the fixed-dose combination group and 13 in 10 patients (10.9%) in the monotherapy group (P = 0.30).

CONCLUSIONS: Fixed-dose combination amlodipine/losartan 5/50 mg was not inferior in terms of reductions in DBP after 8 weeks of treatment and had comparable safety profile to amlodipine 10 mg in patients who did not respond to amlodipine 5 mg monotherapy. ClinicalTrials.gov identifier: NCT00940667.
Full Text
http://www.sciencedirect.com/science/article/pii/S0149291811007247
DOI
10.1016/j.clinthera.2011.11.007
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Seok Min(강석민) ORCID logo https://orcid.org/0000-0001-9856-9227
Youn, Jong Chan(윤종찬)
Cho, Seung Yun(조승연)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/94771
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