Abstract P227: Safety and Efficacy of Losartan/hydrochlorothiazide Combination in Elderly Patients With Morning Hypertension

Abstract

Background: Cardiovascular events occur most frequently in the morning. Elevation of blood pressure (BP) in the early morning (morning hypertension) is characteristic feature of hypertension in the elderly, and is attributed to cardiovascular events. However, treatment of morning hypertension has not been established, especially in the elderly patients. A combination of an angiotensin II receptor blocker (ARB) and hydrochlorothiazide (HCTZ) is a desirable choice of treatment for uncontrollable hypertension by antihypertensive monotherapy. Purpose: The aim of this study was to compare the safety and effectiveness between an ARB/HCTZ combination therapy and high-dose ARB therapy in the elderly (75 years or more) and younger (less than 75 years) patients. Methods: This study enrolled 201 (66 elderly and 135 younger) on-treatment patients having morning hypertension evaluated by home BP self-measurement. Patients were randomly assigned to receive 50mg-losartan/12.5mg-HCTZ combination (Combination) or 100mg-losartan (High-dose) therapy. Results: During the 3-month treatment, the incidence of adverse events of Combination and High-dose therapies was similar in the elderly and younger patients. In the elderly patients, Combination therapy induced greater morning systolic BP reduction than High-dose therapy, whereas the two therapies showed the similar effects on estimated glomerular filtration rate (eGFR), serum K, and uric acid, as well as in younger patients (Table). Conclusions: ARB/HCTZ combination therapy was safe and more effective for controlling morning hypertension than high-dose ARB in the elderly patients, as seen in younger patients.