Clinical Study Of Hydrochlorothiazide Combined With Irbesartan Or Amlodipine In The Treatment Of Essential Hypertension

Background: Hypertension is one of the important risk factors for damage of target organs such as heart,brain and kidney.Current blood pressure control rate is still not ideal.Due to the pathogenesis of hypertension including water and sodium retention,overactivation of sympathetic nervous system and RAAS,two or more drugs with different mechanisms of action are usually needed to improve the antihypertensive effect.Diuretic +ARB,diuretic +CCB are both recommended as first-line antihypertensive regimens in domestic and foreign guidelines.However,there is no definite conclusion as to which combination has better antihypertensive effect and less side effects.Objective: Hydrochlorothiazide,irbesartan and amlodipine are widely used in clinical practice as diuretics,ARB and CCB,respectively.However,it is not clear which combination of hydrochlorothiazide and irbesartan or amlodipine is more effective in reducing blood pressure.The purpose of this study was to compare the efficacy of hydrochlorothiazide in combination with irbesartan or amlodipine in the treatment of grade 1 to 2 essential hypertension and the effects of the two regimens on systemic capacity load,sympathetic nervous system,and RAAS.Method: This study was a blinded,randomized,parallel controlled study.Sixty patients with grade 1 ~ 2 essential hypertension who did not take the drug at the first diagnosis were randomly assigned to either the hydrochlorothiazide/irbesartan group(ARB group,150mg/ hydrochlorothiazide 12.5mg/day)or the hydrochlorothiazide/amlodipine group(CCB group,5mg/hydrochlorothiazide 12.5mg/day)for 8 weeks.Before and after treatment,we will measure the blood pressure in the clinic,24 h dynamic blood pressure,volume load,and basic hypertension test(aldosterone,renin,angiotensin II,aldosterone/renin concentration ratio),plasma catecholamines(dopamine,norepinephrine,epinephrine),electrolytes,renal function indicators.Results: After 8 weeks of treatment,the blood pressure in the clinic and 24 h ambulate blood pressure in both groups were significantly lower than before.In addition to nocturnal diastolic blood pressure,hydrochlorothiazide combined with irbesartan group had a greater reduction in blood pressure than hydrochlorothiazide combined with amlodipine group,and a better blood pressure level was obtained.Compared with before treatment,plasma renin and AngII levels in both groups were higher than before,while aldosterone,norepinephrine and uric acid were also significantly higher in hydrochlorothiazide combined with amlodipine group,and serum potassium was lower than before.Conclusion: For patients with grade 1 to 2 essential hypertension,irbesartan at 150mg/ hydrochlorothiazide at 12.5mg was superior to amlodipine at 5mg/ hydrochlorothiazide at 12.5mg.Although both of the two schemes have good safety,the former has less effect on RAAS,sympathetic nervous system,blood potassium and uric acid,and is a more worthy of promoting the combined antihypertensive scheme.