International guidelines recommended combination of different classes of antihypertensive agents to achieve the targeted blood pressure (BP) in initial treatment for hypertension. However, the optimal combinations are not clarified. The present study was to evaluate the treatment efficacy with the combination of a dihydropyridine calcium-channel blocker amlodipine with diuretics or angiotensin II receptor blocker on reducing the rate of cardiovascular events.
In a randomized, open-label, blinded-endpoint trial, hypertensive patients at high risk for cardiovascular events from 180 clinical centers in China were assigned to receive treatment with either amlodipine plus amiloride/hydrochlorothiazide (n = 6776) or amlodipine plus telmisartan (n = 6766). The primary outcome was the composite of non-fatal stroke, non-fatal myocardial infarction or death from cardiovascular causes.
The median follow-up was 41 months. No between-group difference was observed in mean BP lowering. However, the primary-outcome events were reduced by 24.1% in the amlodipine-diuretics group compared with the amlodipine-telmisartan group (hazard ratio [HR], 0.76; p = 0.005). Of note, compared with amlodipine-telmisartan regiments, amlodipine-diuretics treatment significantly lowered the risk of death from cardiovascular causes (HR, 0.64; p = 0.03) and fatal and nonfatal stroke (HR, 0.78; p = 0.03). Both treatments were safe and well tolerated.
The amlodipine-diuretics combination was more efficacious in reducing cardiovascular events than the amlodipine-telmisartan combination in hypertensive patients with high risk for such events, independent of blood pressure reduction. (ClinicalTrials.gov number, NCT01011660.)
1Clinical Trial and Research Center Beijing Hypertension League Institute, Chinese Hypertension League China, People's Republic of
2Cardiology Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College China, People's Republic of
3Evidence-Based Medicine Cardiovascular Institute and Fuwai Hospital China, People's Republic of
4Traditional Chinese Medicine Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College China, People's Republic of