Abstract
Introduction: Four different antihypertensive drug classes are equivalently recommended in the previous guidelines for first-line treatment of arterial hypertension (HTN). However, it is unclear, whether one of these drugs is more capable than the others to reach blood pressure (BP) control. We sought to compare response rates and BP control in these four classes. Methods: Patients with newly diagnosed mild to moderate HTN on 24h-BP measurements (ABPM) were randomized in a 1:1:1:1 fashion to either perindopril, olmesartan, amlodipin or hydro-chlorothiazide (HCT). ABPM was completed at baseline (BL), and after 4 weeks of half dose (treatment period 1, TP1). If BP control was not reached after TP1, drug-dose was doubled and another ABPM completed after 4 weeks (treatment period 2, TP2). Patients were classified as controlled if 24h mean BP was < 130/80 mmHg, awake BP < 135/85 mmHg, and night BP < 120/70 mmHg, and as optimal if 24h mean BP was 115 – 124/65 – 74 mmHg. Results: 88 patients were randomized: 20 (23%) to perindopril, 23 (26%) to olmesartan, 24 (27%) to amlodipine, and 21 (24%) to HCT. Median 24h mean BP reduction from BL to TP1 was -11/-6 mmHg and from TP1 to TP2 -4/-2 mmHg. The highest BP reduction was reached with olmesartan (-15/-10 mmHg), particularly for diastolic values, the lowest with HCT (-8/-1 mmHg). 27% of patients reached systo-diastolic BP control, with the best control rate with perindopril and olmesartan (40 and 39%), the lowest with HCT (5%), and 21%/18% reached an optimal treatment goal for systolic/diastolic 24h mean values, respectively, after TP1. Three additional participants (4%) reached BP control after TP2. Conclusion: Initial antihypertensive monotherapy failed in most patients (73% uncontrolled, 21%/18% at optimal treatment goal at TP1) even in low-risk patients, with efficacy varying by drug class (inhibitors of the renin-angiotensin-aldosterone system best, HCT least). These findings support guideline-recommended combination therapy.
