Increased efficacy and tolerability with losartan plus hydrochlorothiazidein patients with uncontrolled hypertension and therapy-related symptoms receiving two monotherapies

The efficacy and tolerability of losartan 100 mg/hydrochlorothiazide (HCTZ) 25 mg and enalapril 10 mg/HCTZ 25 mg were compared in a double-blind, rand omized trial in hypertensive patients inadequately controlled and experienc ing side effects on prior therapy. Patients with moderate or severe hyperte nsion, currently treated with at least two single-agent drugs (excluding an giotensin-converting enzyme inhibitors), with a sitting diastolic blood pre ssure (DBP) above 90 mm Hg, and at least one undesirable drug-related sympt om were randomized to once-daily treatment with one of the combinations for 12 weeks. Losartan/HCTZ lowered sitting DBP from the prior therapy baselin e by 13.7 mn and sitting systolic blood pressure 19.3 mm Hg; similar reduct ions occurred enalapril/HCTZ. Trough sitting DBP was reduced to normal leve ls (<90 mm Hg) in 63% of patients switched to the losartan combination and in 58% of those treated with the enalapril combination. Each combination wa s associated with improved tolerability compared with prior therapy, althou gh fewer patients reported each of 24 undesirable symptoms after 12 weeks o f losartan/HCTZ. The improvement from prior therapy in the occurrence of co ugh was significantly greater with losartan/HCTZ (P = .005). Enalapril/HCTZ , but not losartan/HCTZ, increased serum uric acid levels at week 12. In conclusion, the combination of losartan 100 mg/HCTZ 25 mg offers a benef icial therapeutic option for patients with a history of moderate to severe hypertension whose blood pressure is not adequately controlled or who exhib it side effects white on two or more single-agent antihypertensive drugs. I n this population, the switch from prior antihypertensive therapies to once daily losartan 100 mg/HCTZ 25 mg improves blood pressure control and reduc es side effects.