Comparación de la eficacia antihipertensiva de monoterapia en dosis crecientes versus terapia asociada en bajas dosis
Background: When hypertension treatment does not achieve the expected reduction in blood pressure levels, experts recommend increasing the dose of the initially used drug or the addition of a new medication. Aim: To compare the efficacy of increasing doses of losartan or the addition of hydrochlorothiazide to achieve adequate blood pressure levels in patients with hypertension. Patients and methods: Seventy three patients aged 64.4 ± 5.3 years, with stage 1 or 2 essential hypertension were studied. If after four weeks of treatment with losartan 50 mg od, blood pressure levels were still high, the dose was increased to 100 mg od. After four weeks with this new schedule, the treatment was switched to losartan 50 mg and hydrochlorothiazide 12.5 mg for another four weeks. Results: Thirty seven patients normalized blood pressure with losartan 50 mg od. Of the 36 patients that did not respond, 69% achieved a normal blood pressure with losartan 100 mg od and 81% did so with the combination of losartan and hydrochlorothiazide. Combination therapy resulted in a better blood pressure lowering than monotherapy (33.2 ± 3.2 and 29.5 ± 3.4 mm Hg for systolic blood pressure respectively, 16.4 ± 3.2 and 13.2 ± 3.4 mm Hg for diastolic blood pressure, p <0.05). No changes in blood glucose, total and HDL cholesterol, triglycerides, urea nitrogen and uric acid were observed with the combination therapy. Conclusions: In this group of patients, combination therapy achieved better blood pressure levels than monotherapy in high doses.