P1651Combination of valsartan/amlodipine is more effective than bisoprolol/hydrochlorothiazide on reduction of blood pressure variability in patients with moderate or severe hypertension after control

Abstract

Background: Blood Pressure variability (BPV) is associated with an increased incidence for coronary heart disease (CHD), stroke and mortality independent of mean BP. Antihypertensive drug classes may have different effects on BPV in a daily life clinical setting independent from the effects of major confounders such as BP level, age, gender, heart rate and factors suspected to influence the choice of antihypertensive drug class prescription. Aim of the study: The aim of this study is to compare the effect of the combination of Amlodipine plus Valsartan (A/V) to that of Bisoprolol plus hydrochlorothiazide (B/T) on blood pressure variability. Patients and methods: This is a prospective comparative randomized open label study that included 220 hypertensive patients. Patients were either newly diagnosed with moderate and severe hypertension or uncontrolled on monotherapy. Patients were randomized into A/V group that received combination of amlodipine plus valsartan and the B/T group that received combination of bisoprolol plus hydrochlorothiazide. Both groups therapy was up titrated to A10/ V 150 and B 10/ T 25 before adding spironolactone or alfa methyl dopa. 40 patients either lost to followup or BP was not controlled after 8 weeks of therapy and were excluded. The remaining 180 patients were equal in both groups (90 patients in each group). Short term BPV was assessed by 24‐hour ambulatory BP monitoring and expressed as standard deviation (SD) and average reading variability (ARV) during 24 h, daytime and nighttime. Visit to visit BPV was calculated using SD of mean systolic and diastolic blood pressure across visits during follow up period. Results: Age, BMI, sex and heart rate did not show any statistically significant difference between both groups. Although baseline Systolic BP was higher in A/V group yet it reached a higer control rate with lower dose and a faster time to control. Short term BPV assessed by 24‐hour ambulatory BP monitoring during 24 h, daytime and nighttime was lower in A/V group than B/T group (all p<0.001). Visit‐to‐visit BPV was also lower in A/V group g than B/T group (all p<0.001). Conclusion: Apart from reducing BP effectively in moderate and severe hypertensive patients, amlodipine plus valsartan combination was more effective than bisoprolol plus hydrochlorothiazide combination in reducing both 24‐ambulatory BPV and visit to visit BPV within one month after control. (Figure Presented).