Influence of the angiotensin II receptor antagonist losartan on diuretic-induced metabolic effects in elderly hypertensive patients: comparison with a calcium channel blocker

Objective: Diuretic therapy frequently induces Undesirable biochemical chan ges and side effects. We compared metabolic effects of a low-dose diuretic (D) given in combination with an angiotensin II receptor antagonist, losart an (L), with those resulting from a diuretic given in combination with a ca lcium channel blocker, slow-release nifedipine (N). Material and methods: T hirty-seven elderly patients with mild to moderate hypertension (mean age. 71 +/- 3 years) were treated with either L+D (n = 18) or N+D (n = 19) for 1 year. Diuretic therapy included low-dose trichlormethiazide or low-dose fu rosemide in numbers of patients that were similar between L+D and N+D group s. Blood pressure, serum electrolytes, uric acid, blood glucose, renal func tion and lipid parameters were measured at baseline, 6 months and 1 year. R esults: Effective blood pressure control was observed in both groups at 6 m onths, and with further improvement at 1 year, Serum potassium was signific antly decreased from baseline at 6 months (p < 0.01) and 1 year (p < 0.01) in the N+D group, but not in the L+D group. Serum uric acid was significant ly increased from baseline at 6 months (p < 0.01) and 1 year (p < 0.01) in the N+D group, but had minimally decreased at 1 year in the L+D group (p < 0.1). Blood glucose, renal function and lipid parameters did not change in either group. Conclusion: The combination of losartan and low-dose diuretic s effectively treated hypertension in elderly Patients while minimizing the metabolic consequences of diuretic therapy. Larger trials will be necessar y to confirm this finding.