Efficacy and safety of early versus late titration of fixed-dose irbesartan/hydrochlorothiazide: ACTUAL study

Abstract

Hypertension management guidelines recommend titrating antihypertensive drugs stepwise every 46 weeks. We compared efficacy and safety of early versus late titration after 10 weeks' treatment with irbesartan/hydrochlorothiazide. Hypertensive patients uncontrolled on monotherapy were randomized into two groups. In the early titration group (E), patients received irbesartan/ hydrochlorothiazide 150/12.5 mg for 2 weeks; uncontrolled patients were up-titrated to 300/25 mg at weeks 2 and 6. In the late titration group (L), patients received 150/12.5 mg for 6 weeks; uncontrolled patients were up-titrated to 300/25 mg at week 6 (W6). The change of mean systolic (SBP) and diastolic blood pressure (DBP) from baseline to week 10 (W10) were studied using a covariance analysis model. The percentage of controlled patients at W10 was compared between groups using Fisher's exact test. Of 833 patients enrolled from 14 countries, the intent-to-treat (ITT) population included 795 (mean age 58 ± 12 years, female 60%, obesity 38%, diabetes 22%). At W6, mean SBP decrease was: E-28.8 mmHg vs L-26.3 mmHg (p = 0.02). At W10, there was similar mean SBP decrease: E-29.5 mmHg vs L-31.0 mmHg (p = 0.14). The control rate at W10 was 58% (E) and 64% (L), p = 0.06. Serious adverse events were more frequent in E (2.5% vs 0.7%, p = 0.044). Both early and late titration regimens provide similar BP decrease and control rate. © 2011 Scandinavian Foundation for Cardiovascular Research.