Efficacy and Safety of Combination Therapy with Losartan and Hydrochlorothiazide in Elderly Hypertension.
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概要
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We examined the effect and safety of combination therapy with low-dose diuretics (hydrochlorothiazide: HCTZ) and angiotensin II receptor antagonist (losartan) in elderly cases of hypertension, using ambulatory blood pressure monitoring (ABPM). Elderly hypertensive patients (mean age 75±2 years) were treated with either losartan (25-50mg/day) or HCTZ (12.5mg/day) for at least 4 weeks, and then 24-hour blood pressure (BP) was measured by ABPM. Combination therapy with addition of other drug was initiated in 14 patients whose 24-hour systolic BP or daytime systolic BP was over 140mmHg (160mmHg for the patients of 80 years or older). After 4 weeks of the combination therapy, ABPM was repeated. Blood cell count and blood chemistry were also done before and after initiation of combination therapy. In the losartanpreceding group (n=9), the combination therapy with HCTZ reduced 24-hour BP by 19.3±2.3/6.6±2.3mmHg. Similarly, daytime and night time BP decreased by 21.4±4/8.4±2.8mmHg and 15.2±4/4.2±2.4mmHg, respectively. In the HCTZ-preceding group, the combination with losartan also decreased 24-hour BP by 12.2±4.8/3.4±1.4mmHg. The decreases of day time and night time BP were 13.8±6.6/4±1.1mmHg and 10±4.7/3±2.4mmHg, respectively. Heart rate did not change with combination therapy in the losartan-preceding group, while heart rate during daytime tended to decrease by addition of losartan in the HCTZ-preceding group (3.8±1.7/min). Serum electrolytes, uric acid, lipids, renal function and body weight did not change during the study period. Thus, combination therapy of losartan/hydrochlorothiazide seems useful in the treatment of elderly hypertension, showing additive BP lowering effect without metabolic adverse effects.
- 社団法人 日本老年医学会の論文