VolumeVol. 54 • Number No. 1 • January - March 2016 Back
A Post Marketing Surveillance Study To Evaluate the Efficacy and Safety of Fixed Dose Amlodipine — Losartan Potassium for the Treatment of Hypertension in the Philippines
Authors: Leandro C. Bongosia, Cristy Mendoza, Lucky Cuenza
DOI: 10.65564/pjim.14db31e9d4
Date of Publication: March 2016
Abstract
Background: This open label post marketing study was conducted to determine the efficacy and safety of a fixed dose combination of amlodipine - losartan in the treatment of hypertension in Filipino patients.
Methods: Eight hundred eighteen (818) male and female ambulatory patients aged 18-70 years with mild to moderate hypertension who were initially not responding to monotherapy were enrolled. Patients were prescribed (amlodipine 5mg - losartan potassium 50mg) as therapy. The primary end point was the change from baseline to sixth week in in both systolic and diastolic blood pressure. Details of any adverse event reported or noted during the treatment with the combination were recorded.
Results: There were 680 patients eligible for efficacy analysis. Mean age of patients was 53.36 ±11.3 years. One hundred twenty eight (15.6%) had dyslipidemia, 139 (16.9) had diabetes, while 7.7% had previously diagnosed cardiovascular disease. At baseline, patients had a mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) of 159 ± 18.3 mmHg and 96 ± 10.8 mmHg respectively. There was a statistically significant (P < 0.001) mean reduction of 30.87 ± 16.98 mmHg in SBP and 15.10 ± 10.68 mmHg in DBP at the end of follow up. By the 6th week 79.6% of patients achieved adequate SBP control of sat the while 76.6% had optimal diastolic BP. The differences in blood pressure were all statistically significant even when accounting for other comorbidities. Adverse events were noted in 2.9% with headache and peripheral edema being the most common side effects reported.
Conclusion: The results demonstrate that a fixed dose combination of amlodipine - losartan provides an effective and generally well-tolerated treatment option for hypertension in Filipino patients especially those with multiple cardiovascular risk factors who are unresponsive to monotherapy.
Keywords: hypertension, losartan, amlodipine
References
- Kottke TE, Stroebel RJ, Hoffman RS, JNC 7--it’s more than high blood pressure, JAMA. 2003 May 21;289(19):2573-5.
- Sison J, Arceo L, Trinidad E et al, , PRESYON 2 Report Of The Council Of Hypertension”. PHA Annual Convention. Manila: Philippine Heart Association, 2007
- Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW et al , The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report, JAMA. 2003 May 21;289(19):2560-72.
- Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M et al, 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC), Eur Heart J. 2013 Jul;34(28):2159-219. doi: 10.1093/eurheartj/eht151.
- Lawes, C., Rodgers, A., Bennett, D. et al, Blood pressure and cardiovascular disease in the Asia Pacific region. J Hypertens. 2003;21:707–716
- Crawford MH. Cardiology Clinics: Drug Therapy of Cardiovascular Disease. Vol 19, No. 2 May 2001
- Lewis,J.A.(1981).Post-marketing surveillance: how many patients? Trends in Pharmacological Sciences 1981;2,93-94
- Gokhale N, Shahani S, Pawar D, Efficacy and safety of losartan-amplodipine combination--an Indian postmarketing surveillance experience, J Indian Med Assoc. 2002 Mar; 100(3):207-8.
- Dickerson J, Hingorani A and Ashby M (1999). Optimisation of antihypertensive treatment by crossover rotation of four major classes. Lancet 353 2008-13.
- Mancia G, Laurent S, Agabiti-Rosei E, Ambrosioni E, Burnier M, Caulfield MJ, et al; European Society of Hypertension. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens 2009;27:2121-58
- Epstein M, Bakris G. Newer approaches to antihypertensive therapy. Use of fixed-dose combination therapy. Arch Intern Med. 1996;156:1969–78.
- Gradman AH, Basile JN, Carter BL, Bakris GL; American Society of Hypertension Writing Group. Combination therapy in hypertension. J Am Soc Hypertens 2010;4:42-50.
- Sanz G, Fuster V. Fixed-dose combination therapy and secondary cardiovascular prevention: Rationale, selection of drugs and target population. Nat Clin Pract Cardiovasc Med. 2009;6:101–10.
- Pimenta E, Oparil S. Fixed combinations in the management of hypertension: Patient perspectives and rationale for development and utility of the olmesartan-amlodipine combination. Vasc Health Risk Manag. 2008;4:653–64.
- Jamerson, K, e t a l . , Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N Engl J Med, 2008. 359(23): p. 2417-28.
- Bakris, G.L., Combined therapy with a calcium channel blocker and an angiotensin II type 1 receptor blocker. J Clin Hypertens (Greenwich), 2008. 10(1 Suppl 1): p. 27-32.
- Devi MA, Sriram S, Rajalingam B, Anthraper AR, Varghese RS, Phani VA. Evaluation of ratio nality of fixed dose combinations of cardiovascular drugs in a multi-speciatlity tertiary carehospitalin Coimbatore, Tamil Nadu, India. Hygeia J Durgs Med. 2012;4:51–8.
- Kim SH, Ryu KH, Lee N-H, et al. Efficacy of fixed-dose amlodipine and losartan combination compared with amlodipine monotherapy in stage 2 hypertension: a randomized, double blind, multicenter study. BMC Research Notes. 2011;4:461. doi:10.1186/1756-0500- 4-461.
- Eduardo P Single Sevikar (2009). Combination Therapy for the Treatment of Hypertension. Clinical Medicine: Therapeutics 1 703–709.