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https://observatorio.fm.usp.br/handle/OPI/14517
Title: | Effectiveness of chlorthalidone/amiloride versus losartan in patients with stage I hypertension: results fromthe PREVER-treatment randomized trial |
Authors: | FUCHS, Flavio D.; SCALA, Luiz Cesar N.; VILELA-MARTIN, Jose F.; MELLO, Renato Bandeira de; MOSELE, Francisca; WHELTON, Paul K.; POLI-DE-FIGUEIREDO, Carlos E.; ALENCASTRO, Paulo Ricardo de; SILVA, Ricardo Pereira e; GUS, Miguel; BORTOLOTTO, Luiz Aparecido; SCHLATTER, Rosane; CESARINO, Evandro Jose; CASTRO, Iran; FIGUEIREDO NETO, Jose A.; CHAVES, Hilton; STEFFENS, Andre Avelino; ALVES, Joao Guilherme; BRANDAO, Andrea Araujo; SOUSA, Marcos R. de; JARDIM, Paulo Cesar; MOREIRA, Leila B.; FRANCO, Roberto Silva; GOMES, Marco Mota; AFIUNE NETO, Abrahao; FUCHS, Felipe Costa; SOBRAL FILHO, Dario C.; NOBREGA, Antonio C.; NOBRE, Fernando; BERWANGER, Otavio; FUCHS, Sandra C. |
Citation: | JOURNAL OF HYPERTENSION, v.34, n.4, p.798-806, 2016 |
Abstract: | Objectives:To compare the blood pressure (BP)-lowering efficacy of a chlorthalidone/amiloride combination pill with losartan, during initial management of stage I hypertension.Methods: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 90-99mmHg) following 3 months of a lifestyle intervention. Participants were randomized to 12.5/2.5mg of chlorthalidone/amiloride (N=333) or 50mg 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 10mg) and propranolol (40 and 80mg twice daily) were added as open-label drugs in a progressive fashion. At the end of follow-up, 609 (93%) participants were evaluated.Results: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 (28.540.4 versus 16.226.7mg, P=0.09).Conclusion:Treatment with a combination of chlorthalidone and amiloride compared with losartan yielded a greater reduction in BP.Clinical trials registration number:NCT00971165. |
Appears in Collections: | Artigos e Materiais de Revistas Científicas - HC/InCor Artigos e Materiais de Revistas Científicas - ODS/03 |
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