Randomized study to compare valsartan ± HCTZ versus amlodipine ± HCTZ strategies to maximize blood pressure control
Dion Zappe1, Cheraz Cherif Papst2, Philippe Ferber3, On behalf of the PROMPT investigators1Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA; 2Novartis Pharma Ag, Basel, Switzerland; 3Roche Pharmaceuticals, Basel, SwitzerlandObjective: Delays in achieving blood pressure (BP) control may in...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2009-10-01
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| Series: | Vascular Health and Risk Management |
| Online Access: | http://www.dovepress.com/randomized-study-to-compare-valsartan-plusmn-hctz-versus-amlodipine-pl-a3661 |
| _version_ | 1818940569498419200 |
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| author | Dion Zappe Cheraz Cherif Papst Philippe Ferber et al. |
| author_facet | Dion Zappe Cheraz Cherif Papst Philippe Ferber et al. |
| author_sort | Dion Zappe |
| collection | DOAJ |
| description | Dion Zappe1, Cheraz Cherif Papst2, Philippe Ferber3, On behalf of the PROMPT investigators1Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA; 2Novartis Pharma Ag, Basel, Switzerland; 3Roche Pharmaceuticals, Basel, SwitzerlandObjective: Delays in achieving blood pressure (BP) control may increase morbidity and mortality in patients with hypertension. Thus, deciding which antihypertensive agent to use and at what dosage, in addition to determining when to initiate combination therapy and which agents to combine, is important for achieving BP control.Methods: This randomized, double-blind, 14-week study was conducted to compare the efficacy and tolerability of various doses of valsartan ± hydrochlorothiazide (HCTZ) versus amlodipine ± HCTZ for maximizing BP control in 1,285 patients with uncontrolled hypertension. Patients with stage 1 hypertension and naïve to antihypertensive therapy (33.9%) started valsartan 160 mg or amlodipine 5 mg. Treatment-naïve patients with stage 2 hypertension (13.5%) or those uncontrolled on current antihypertensive monotherapy (52.6%) started valsartan 160 mg/HCTZ 12.5 mg or amlodipine 10 mg. At weeks 4, 8, and 11, patients not achieving BP control were up-titrated (maximum: valsartan 320 mg/HCTZ 25 mg, amlodipine 10 mg/HCTZ 25 mg).Results: At study end, 78.8% of patients on valsartan ± HCTZ were controlled (BP < 140/90 mmHg) and still on study medication versus 67.8% on amlodipine ± HCTZ (P < 0.0001). Amlodipine-treated patients had a higher incidence of peripheral edema (22.4% vs 2.2%) and associated discontinuations (7.3% vs <1%). Initiating therapy earlier with valsartan/HCTZ, rather than  titrating monotherapy to its maximum dose before adding a second agent, was superior to amlodipine monotherapy or amlodipine ± HCTZ for achieving BP control, and avoided excessive treatment adjustments and maintained tolerability.Keywords: efficacy, hydrochlorothiazide, hypertension, combination therapy, titration, tolerability |
| first_indexed | 2024-12-20T06:41:44Z |
| format | Article |
| id | doaj.art-860097aac5fb4473b1212e7785acc8c9 |
| institution | Directory Open Access Journal |
| issn | 1176-6344 1178-2048 |
| language | English |
| last_indexed | 2024-12-20T06:41:44Z |
| publishDate | 2009-10-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Vascular Health and Risk Management |
| spelling | doaj.art-860097aac5fb4473b1212e7785acc8c92022-12-21T19:49:49ZengDove Medical PressVascular Health and Risk Management1176-63441178-20482009-10-012009default883892Randomized study to compare valsartan ± HCTZ versus amlodipine ± HCTZ strategies to maximize blood pressure controlDion ZappeCheraz Cherif PapstPhilippe Ferberet al.Dion Zappe1, Cheraz Cherif Papst2, Philippe Ferber3, On behalf of the PROMPT investigators1Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA; 2Novartis Pharma Ag, Basel, Switzerland; 3Roche Pharmaceuticals, Basel, SwitzerlandObjective: Delays in achieving blood pressure (BP) control may increase morbidity and mortality in patients with hypertension. Thus, deciding which antihypertensive agent to use and at what dosage, in addition to determining when to initiate combination therapy and which agents to combine, is important for achieving BP control.Methods: This randomized, double-blind, 14-week study was conducted to compare the efficacy and tolerability of various doses of valsartan ± hydrochlorothiazide (HCTZ) versus amlodipine ± HCTZ for maximizing BP control in 1,285 patients with uncontrolled hypertension. Patients with stage 1 hypertension and naïve to antihypertensive therapy (33.9%) started valsartan 160 mg or amlodipine 5 mg. Treatment-naïve patients with stage 2 hypertension (13.5%) or those uncontrolled on current antihypertensive monotherapy (52.6%) started valsartan 160 mg/HCTZ 12.5 mg or amlodipine 10 mg. At weeks 4, 8, and 11, patients not achieving BP control were up-titrated (maximum: valsartan 320 mg/HCTZ 25 mg, amlodipine 10 mg/HCTZ 25 mg).Results: At study end, 78.8% of patients on valsartan ± HCTZ were controlled (BP < 140/90 mmHg) and still on study medication versus 67.8% on amlodipine ± HCTZ (P < 0.0001). Amlodipine-treated patients had a higher incidence of peripheral edema (22.4% vs 2.2%) and associated discontinuations (7.3% vs <1%). Initiating therapy earlier with valsartan/HCTZ, rather than  titrating monotherapy to its maximum dose before adding a second agent, was superior to amlodipine monotherapy or amlodipine ± HCTZ for achieving BP control, and avoided excessive treatment adjustments and maintained tolerability.Keywords: efficacy, hydrochlorothiazide, hypertension, combination therapy, titration, tolerabilityhttp://www.dovepress.com/randomized-study-to-compare-valsartan-plusmn-hctz-versus-amlodipine-pl-a3661 |
| spellingShingle | Dion Zappe Cheraz Cherif Papst Philippe Ferber et al. Randomized study to compare valsartan ± HCTZ versus amlodipine ± HCTZ strategies to maximize blood pressure control Vascular Health and Risk Management |
| title | Randomized study to compare valsartan ± HCTZ versus amlodipine ± HCTZ strategies to maximize blood pressure control |
| title_full | Randomized study to compare valsartan ± HCTZ versus amlodipine ± HCTZ strategies to maximize blood pressure control |
| title_fullStr | Randomized study to compare valsartan ± HCTZ versus amlodipine ± HCTZ strategies to maximize blood pressure control |
| title_full_unstemmed | Randomized study to compare valsartan ± HCTZ versus amlodipine ± HCTZ strategies to maximize blood pressure control |
| title_short | Randomized study to compare valsartan ± HCTZ versus amlodipine ± HCTZ strategies to maximize blood pressure control |
| title_sort | randomized study to compare valsartan amp plusmn hctz versus amlodipine amp plusmn hctz strategies to maximize blood pressure control |
| url | http://www.dovepress.com/randomized-study-to-compare-valsartan-plusmn-hctz-versus-amlodipine-pl-a3661 |
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