Department of Cardiology, Asahikawa Medical University , Asahikawa , Japan .
Clin Exp Hypertens. 2015;37(5):411-9. doi: 10.3109/10641963.2014.995802. Epub 2015 Apr 9.
Combination antihypertensive therapy with an angiotensin receptor blocker (ARB) and a calcium channel blocker (CCB) or diuretics is common. This subanalysis investigated blood pressure (BP) variability in patients receiving ARB-based combination therapy.
In a prospective, randomized, open-label trial, hypertensive outpatients (≥65 years) who did not achieve their target BP with ARB monotherapy switched to losartan 50 mg/hydrochlorothiazide 12.5 mg (ARB + D) or ARB plus amlodipine 5 mg (ARB + C) for 12 months. Clinic BP and heart rate (HR), measured every 3 months, visit-to-visit variability and seasonal variation were evaluated.
No significant between-group differences in average, maximum, or minimum systolic or diastolic BP, or HR, were found. Visit-to-visit BP variability (systolic) was significantly higher in the ARB + D group than in the ARB + C group. When each group was subdivided into two seasonal groups (summer and winter), no significant between-group differences in BP were found. Multivariate regression analyses showed a tendency toward negative correlation between outdoor temperature and urinary albumin:creatinine ratio and estimated glomerular filtration rate at 12 months in the ARB + D group.
Combination therapy with an ARB plus a CCB may be preferable to that with an ARB plus diuretics for decreasing BP variability. As for seasonal variability, both treatments can be used safely regardless of season.
联合使用血管紧张素受体阻滞剂（ARB）和钙通道阻滞剂（CCB）或利尿剂的降压治疗较为常见。本亚分析旨在研究接受 ARB 为基础的联合治疗的患者血压（BP）变异性。
在一项前瞻性、随机、开放标签试验中，血压未达标（≥65 岁）的高血压门诊患者在接受 ARB 单药治疗后转换为氯沙坦 50mg/氢氯噻嗪 12.5mg（ARB+D）或 ARB+氨氯地平 5mg（ARB+C）治疗，疗程为 12 个月。每 3 个月测量一次诊室 BP 和心率（HR），评估访间血压变异性和季节性变化。
平均、最大和最小收缩压或舒张压以及 HR 方面，两组间无显著差异。ARB+D 组的访间 BP 变异性（收缩压）显著高于 ARB+C 组。将每组分为夏季和冬季两个季节性组时，两组间 BP 无显著差异。多变量回归分析显示，ARB+D 组在 12 个月时，室外温度与尿白蛋白：肌酐比值和估算肾小球滤过率呈负相关趋势。
ARB 联合 CCB 的治疗方案可能比 ARB 联合利尿剂更有助于降低 BP 变异性。关于季节性变异性，无论季节如何，两种治疗方案都可以安全使用。
