Office and Ambulatory Blood Pressure–Lowering Effects of Combination Valsartan/Hydrochlorothiazide vs Hydrochlorothiazide-Based Therapy in Obese, Hypertensive Patients


Leopoldo Raij, MD, University of Miami-Nephrology, A-1009 Veterans Affairs Medical Center, 1201 NW 16th Street, Miami, FL 33125-1624


J Clin Hypertens (Greenwich). 2011;13:731–738. ©2011 Wiley Periodicals, Inc.

The authors evaluated the blood pressure (BP)–lowering effects of combination valsartan/hydrochlorothiazide (HCTZ) vs amlodipine/HCTZ in a 16-week, double-blind, randomized, forced-titration study and ambulatory BP monitoring (ABPM) substudy involving centrally obese hypertensive patients 40 years and older. Patients were started on valsartan/HCTZ 160/12.5 mg or HCTZ 12.5 mg monotherapy, force-titrated at week 4 to valsartan/HCTZ 320/25 mg and HCTZ 25 mg, respectively. The HCTZ group initiated amlodipine 5 mg at week 8 and 10 mg at week 12. A subset of patients had 24-hour ABPM at baseline and weeks 8 and 16. At week 16 in the intent-to-treat population (n=401), valsartan/HCTZ and amlodipine/HCTZ lowered office systolic BP (−30.6 vs −28.3 mm Hg; P=.14). In the ABPM subgroup (n=111), valsartan/HCTZ was more effective than amlodipine/HCTZ in reducing 24-hour systolic BP (−20.6 vs −14.5 mm Hg; P=.011). In obese hypertensive patients, valsartan/HCTZ reduced office BP similar to amlodipine/HCTZ but lowered 24-hour systolic BP more. J Clin Hypertens (Greenwich). ****;**:**–**.