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Antihypertensive Efficacy of the Losartan/Hydrochlorothiazide Combination and its Effect on Plasma B- Type Natriuretic Peptide in Hypertensive Patients Uncontrolled by Angiotensin II Type 1 Receptor Antagonist-Based Therapy

A Multicentre Prospective Observational Study

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Abstract

Background and Objectives: Although strict blood pressure (BP) control is effective in the prevention of cardiovascular events, it is often insufficient in many hypertensive patients. B-type natriuretic peptide (BNP) has been shown to be associated with cardiovascular events. We investigated the effects of the losartan/hydrochlorothiazide combination on BP and plasma BNP in hypertensive patients uncontrolled by an angiotensin II type 1 receptor antagonist (angiotensin receptor blocker [ARB])-based therapy.

Methods: In a multicentre prospective observational study, we enrolled 185 patients aged 36–79 years (mean age 63.8 years) with essential hypertension but without symptoms of heart failure who received an ARB-based therapy for ≥3 months but failed to achieve a target BP recommended by the Japanese Society of Hypertension (JSH). ARBs were switched to losartan (LOS) 50 mg/hydrochlorothiazide (HCTZ) 12.5 mg. The anti-hypertensive efficacy, safety, and effects of this combination on blood biochemical parameters and plasma BNP were evaluated for 12 months.

Results: Mean ± SD systolic and diastolic BP decreased from 152 ± 13/87 ± 10 mmHg to 128 ± 14/74 ± 10 mmHg, respectively, after 12 months (p < 0.001). Mean ± SD plasma BNP levels decreased significantly from 46.0 ± 83.0 pg/mL to 40.8 ± 68.0 pg/mL (p < 0.05). The percentage of patients who achieved the JSH 2004 target BP was 51% after 12 months; the percentage was 63% in elderly patients aged ≥65 years without complications, and 43% in patients with concomitant diabetes mellitus or chronic kidney disease. No association was found between a decrease in plasma BNP levels and BP, age, body mass index or estimated glomerular filtration rate. There was a significant increase in serum uric acid and a decrease in serum potassium, but both were within the range of normal values. Adverse events were observed in 8.6% of the patients.

Conclusion: Antihypertensive treatment using two types of drugs (LOS/HCTZ) with different mechanisms yielded potent antihypertensive efficacy with safety and decreased plasma BNP levels.

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Acknowledgements

This study was supported by a research grant from the clinical research support project by the Japan Heart Foundation. The authors alone are responsible for the content and writing of the paper. The authors have no conflicts of interest that are directly relevant to the content of this study.

Southern Heart Conference Study Group members (in alphabetical order): Noriyasu Fujino, Yutaka Fukuizumi, Takashi Inoue, Hiroyuki Kohno, Katsuhiko Kubara, Hidehiko Morinaga, Norihiko Morinaga, Eiichi Murayama, Shunichi Nagahama, Kensuke Nomiyama, Keiji Oi, Katsunori Osada, Yoji Sagara, Shigeki Sako, Manabu Sasaguri, Hideaki Shigematsu, Ichiro Shimada, Ryuji Shimamura, Masanori Shimizu, Nobuhiro Suematsu, Tomomasa Suematsu, Kazuyuki Takata, Eiji Tatewaki, Masahisa Terasawa, Yasuhiro Umeki, Sakon Yatabe, and Misao Yamasaki.

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Authors and Affiliations

  1. Department of Cardiology and Internal Medicine, Fukuoka Red Cross Hospital, 3-1-1 Ohkusu, Minami-ku, Fukuoka, 8158555, Japan

    Hiroshi Meno MD, Tetsuji Inou & Michiko Tanaka

  2. Southern Heart Conference Study Group, Fukuoka, Japan

    Yoshihiro Tsuchiya, Yuhei Shiga, Kenji Kobayashi, Yuichiro Nakamura, Takeaki Ota & Ichiro Kubara

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  1. Hiroshi Meno MD
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  2. Tetsuji Inou
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Correspondence to Hiroshi Meno MD.

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Meno, H., Inou, T., Tanaka, M. et al. Antihypertensive Efficacy of the Losartan/Hydrochlorothiazide Combination and its Effect on Plasma B- Type Natriuretic Peptide in Hypertensive Patients Uncontrolled by Angiotensin II Type 1 Receptor Antagonist-Based Therapy. Clin Drug Investig 32, 171–178 (2012). https://doi.org/10.2165/11597620-000000000-00000

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