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Abstract

The addition of hydrochlorothiazide (HTZ) to nonresponders patients to losartan (LOS) is commonly used. However, the lack in beneficial effect in vascular risk provided by diuretic may be related to potentially antagonistic metabolic effects on glucose and lipid profile. The aim of this study was to evaluate the efficacy of doxazosin (DOX), once daily dose, vs HTZ, once daily dose, in patients with mild to moderate essential hypertension, not adequately controlled by concomitant treatment with losartan .

This 8 months randomised, crossover study was conducted in 31 patients with mild to moderate essential hypertension not adequately controlled with losartan. They were randomised in two groups. group A received LOS 50 mg plus DOX 2-4 mg o.i.d. and patients in group B received LOS 50mg plus HTZ 12,5 mg o.i.d. during sixteen weeks. After two weeks wash-out period, croossover was performed. Subsequently, patients receive 16 weeks treatment with the alternative medication ( group A received LOS 50mg plus HTZ 12,5 mg and group B received LOS 50 mg plus DOX 2-4 mg o.i.d.) Blood pressure, total serum cholesterol, LDL-cholesterol, HDL-cholesterol, baseline glycemia, serum creatinine, uric acid, sodium, potassium and urea were measured at baseline, after sixteen weeks, after the wash-out period (only blood pressure), and at the end of the study. All side effects that occurred during the study were documented.

Patients treated with LOS plus DOX showed similar decrease of blood pressure (L SBP= -40,12 ± 27,2 mm Hg; L DBP= -15,45 ±11,12 mm Hg) than patients treated with LOS plus HTZ ( L SBP = -44,8 ± 26,19 mm Hg); LDBP=- 12,96 ± 8,56 mm Hg), but the doxazosin group also showed an statistically significant decreased in the serum lipid profile and glycemia. Furthermore, using the Framingham based cardiovascular risk tables, the number needed to treat (NNT) was 25 (to avoid fatal or non fatal cardiovascular event in ten years) in the group treated with doxazosin, in comparison with NNT = 86 of the group treated with HTZ.

Conclusion: Though the two antihypertensive treatments were valid in order to decrease blood pressure, the cardiovascular risk in those patients treated with losartan plus doxazosina, decreases significantly compared to those treated with the conventional association of losartan plus hydrochlorothiazide.

losartan, Doxazosin versus hydrochlorothiazide, Randomised crossover trial
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© American Journal of Hypertension, Ltd. 2001
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