ABSTRACT
The most effective and accurate treatment of hypertensive patients reduces cardiovascular events and improves the quality of life. This study compared the efficacy and safety of combined [combination therapy] with an angiotensin-receptor blocker [ARB] a calcium-channel blocker [CCB] [Losartan / Amloidipine 50/10mg] vs maximal combination doses of ARB with hydrochlorothiazide [Losartan /HCTZ 100/25 mg] and maximal combination doses of CCB with HCTZ [Amlodipine /HCTZ 10/25 mg] in the management of stage 2 hypertension. This randomized clinical trial [RTC] comprised 478 hypertensive patients with mean age 50.5 +/- 5.21 years, and took place between January 2010 and December 2011 in Vasei Hospital clinic in Sabzevar. Antihypertensive drugs were washed out after 5 days of discontinuation of drugs and the patients with mean blood pressure in sitting position >/= 160 and <200 mmHg in systole and >/= 100 and <110 mmHg in diastole were randomized into three groups: Losartan / Amlodipine 50/10 mg [n =164], Losartan / HCTZ 100/25 mg [n =155] and Amlodipine / HCTZ 10/25 mg [n =159]. The end point was reaching the blood pressure below 140/90 within 56 days of treatment in each group. There was a significant difference in systolic blood pressure reductions between treatment groups [P<0.001] and also there was a significant difference between groups in reducing diastolic blood pressure [P<0.01]. The highest systolic and diastolic blood pressure reduction respectively was found in Amlodipine/losartane and losartane/HTCZ group. The ANCOVA analysis revealed that only treatment regimen had a significant effect [P=0.01] and other factor including Age, Gender, Diabetes Mellitus, Smoking and High serum cholesterol didn't have significant effect on blood pressure reduction. ARB/CCB combination therapy reduced blood pressure more effectively than the maximal doses of ARB or CCB with HCTZ in stage 2 hypertensive patients within this period of study