Produção Nacional
Revisado por pares
Effectiveness of chlorthalidone/amiloride versus losartan in patients with stage I hypertension
2016; Lippincott Williams & Wilkins; Volume: 34; Issue: 4 Linguagem: Inglês
10.1097/hjh.0000000000000837
ISSN1473-5598
AutoresFlávio Danni Fuchs, Luiz César Nazário Scala, José Fernando Vilela-Martin, Renato Gorga Bandeira de Mello, Francisca Mosele, Paul K. Whelton, Carlos Eduardo Poli‐de‐Figueiredo, Paulo Ricardo de Alencastro, Ricardo Pereira e Silva, Miguel Gus, Luiz Aparecido Bortolotto, Rosane Paixão Schlatter, Evandro José Cesarino, Iran Castro, José Albuquerque de Figueiredo Neto, Hilton Chaves, André Avelino Steffens, João Guilherme Bezerra Alves, Andréa Araújo Brandão, Marcos Roberto de Sousa, Paulo César Brandão Veiga Jardim, Leila Beltrami Moreira, Roberto Silva Franco, Marco Mota Gomes, Abrahão Afiune Neto, Felipe Costa Fuchs, Dário Celestino Sobral Filho, Antônio Cláudio Lucas da Nóbrega, Fernando Nobre, Otávio Berwanger, Sandra Cristina Pereira Costa Fuchs,
Tópico(s)Renal function and acid-base balance
ResumoTo compare the blood pressure (BP)-lowering efficacy of a chlorthalidone/amiloride combination pill with losartan, during initial management of stage I hypertension.In a randomized, double-blind, controlled trial, 655 participants were followed for 18 months in 21 Brazilian academic centers. Trial participants were adult volunteers aged 30-70 years with stage I hypertension (BP 140-159 or 90-99 mmHg) following 3 months of a lifestyle intervention. Participants were randomized to 12.5/2.5 mg of chlorthalidone/amiloride (N = 333) or 50 mg of losartan (N = 322). If BP remained uncontrolled after 3 months, study medication dose was doubled, and if uncontrolled after 6 months, amlodipine (5 and 10 mg) and propranolol (40 and 80 mg twice daily) were added as open-label drugs in a progressive fashion. At the end of follow-up, 609 (93%) participants were evaluated.The difference in SBP during 18 months of follow-up was 2.3 (95% confidence interval: 1.2 to 3.3) mmHg favoring chlorthalidone/amiloride. Compared with those randomized to diuretic, more participants allocated to losartan had their initial dose doubled and more of them used add-on antihypertensive medication. Levels of blood glucose, glycosilated hemoglobin, and incidence of diabetes were no different between the two treatment groups. Serum potassium was lower and serum cholesterol was higher in the diuretic arm. Microalbuminuria tended to be higher in patients with diabetes allocated to losartan (28.5 ± 40.4 versus 16.2 ± 26.7 mg, P = 0.09).Treatment with a combination of chlorthalidone and amiloride compared with losartan yielded a greater reduction in BP.NCT00971165.
Referência(s)