OBJECTIVE: To compare the antihypertensive efficacy and safety of once-daily triple therapy with amlodipine (Aml) 10 mg, valsartan (Val) 320 mg, and hydrochlorothiazide (HCTZ) 25 mg versus dual-therapy combinations of these components in patients with moderate to severe hypertension. RESEARCH DESIGN: Subgroup analysis of a multinational, randomized, double-blind, parallel-group, active-controlled trial. METHODS: After antihypertensive washout and a placebo run-in of up to 4 weeks, 2271 patients were randomly allocated in a 1:1:1:1 ratio to receive Aml/Val/HCTZ triple therapy or dual therapy with Val/HCTZ, Aml/Val, or Aml/HCTZ for 8 weeks. Forced titration to the full dose was done over the first 2 weeks of treatment. Efficacy and safety parameters were determined by age group (<65 vs. ≥65 years), gender, race (White vs. Black), ethnicity (Hispanic/Latino vs. non-Hispanic/Latino), and body mass index (BMI, <30 vs. ≥30 kg/m²). MAIN OUTCOME MEASURES: Change from baseline to endpoint in mean sitting systolic blood pressure (MSSBP) and mean sitting diastolic blood pressure (MSDBP); blood pressure (BP) control rate <140/90 mmHg. RESULTS:Triple therapy was numerically superior and, for the majority of comparisons, statistically superior to each dual therapy in reducing MSSBP and MSDBP and in improving BP control rates in all subgroups. Across subgroups, triple therapy reduced MSSBP by 5.7-10.7 mmHg more than Val/HCTZ, 3.4-8.3 mmHg more than Aml/Val, and 4.4-9.4 mmHg more than Aml/HCTZ. Triple therapy was well tolerated across all subgroups. Limitations of our analysis included the lack of stratification of patients by subgroup at randomization and the small sample size of some subgroups (e.g., Blacks, elderly). CONCLUSIONS:Triple therapy with Aml/Val/HCTZ is effective and well tolerated in patients with moderate to severe hypertension regardless of age, gender, race, ethnicity, or BMI. TRIAL REGISTRATION NUMBER: NCT00327587.
RCT Entities:
OBJECTIVE: To compare the antihypertensive efficacy and safety of once-daily triple therapy with amlodipine (Aml) 10 mg, valsartan (Val) 320 mg, and hydrochlorothiazide (HCTZ) 25 mg versus dual-therapy combinations of these components in patients with moderate to severe hypertension. RESEARCH DESIGN: Subgroup analysis of a multinational, randomized, double-blind, parallel-group, active-controlled trial. METHODS: After antihypertensive washout and a placebo run-in of up to 4 weeks, 2271 patients were randomly allocated in a 1:1:1:1 ratio to receive Aml/Val/HCTZ triple therapy or dual therapy with Val/HCTZ, Aml/Val, or Aml/HCTZ for 8 weeks. Forced titration to the full dose was done over the first 2 weeks of treatment. Efficacy and safety parameters were determined by age group (<65 vs. ≥65 years), gender, race (White vs. Black), ethnicity (Hispanic/Latino vs. non-Hispanic/Latino), and body mass index (BMI, <30 vs. ≥30 kg/m²). MAIN OUTCOME MEASURES: Change from baseline to endpoint in mean sitting systolic blood pressure (MSSBP) and mean sitting diastolic blood pressure (MSDBP); blood pressure (BP) control rate <140/90 mmHg. RESULTS: Triple therapy was numerically superior and, for the majority of comparisons, statistically superior to each dual therapy in reducing MSSBP and MSDBP and in improving BP control rates in all subgroups. Across subgroups, triple therapy reduced MSSBP by 5.7-10.7 mmHg more than Val/HCTZ, 3.4-8.3 mmHg more than Aml/Val, and 4.4-9.4 mmHg more than Aml/HCTZ. Triple therapy was well tolerated across all subgroups. Limitations of our analysis included the lack of stratification of patients by subgroup at randomization and the small sample size of some subgroups (e.g., Blacks, elderly). CONCLUSIONS: Triple therapy with Aml/Val/HCTZ is effective and well tolerated in patients with moderate to severe hypertension regardless of age, gender, race, ethnicity, or BMI. TRIAL REGISTRATION NUMBER: NCT00327587.
Authors: William C Cushman; Charles E Ford; Jeffrey A Cutler; Karen L Margolis; Barry R Davis; Richard H Grimm; Henry R Black; Bruce P Hamilton; Joanne Holland; Chuke Nwachuku; Vasilios Papademetriou; Jeffery Probstfield; Jackson T Wright; Michael H Alderman; Robert J Weiss; Linda Piller; Judy Bettencourt; Sandra M Walsh Journal: J Clin Hypertens (Greenwich) Date: 2002 Nov-Dec Impact factor: 3.738
Authors: Aram V Chobanian; George L Bakris; Henry R Black; William C Cushman; Lee A Green; Joseph L Izzo; Daniel W Jones; Barry J Materson; Suzanne Oparil; Jackson T Wright; Edward J Roccella Journal: Hypertension Date: 2003-12-01 Impact factor: 10.190
Authors: Katharina Wolf-Maier; Richard S Cooper; José R Banegas; Simona Giampaoli; Hans-Werner Hense; Michel Joffres; Mika Kastarinen; Neil Poulter; Paola Primatesta; Fernando Rodríguez-Artalejo; Birgitta Stegmayr; Michael Thamm; Jaakko Tuomilehto; Diego Vanuzzo; Fenicia Vescio Journal: JAMA Date: 2003-05-14 Impact factor: 56.272
Authors: Bryan Williams; Neil R Poulter; Morris J Brown; Mark Davis; Gordon T McInnes; John F Potter; Peter S Sever; Simon McG Thom Journal: BMJ Date: 2004-03-13