To compare the BP lowering effect of ARBs and thiazide diuretics in high sodium intake patients with mild to moderate hypertension.Design and Method:
This research was a multicenter randomized double-blinded parallel controlled trial. Eligible participants were randomly divided into T40 and H25 groups, with 3 follow-ups, scheduled on the 15th, 30th and 60th day to compare the difference of average BP decrease, blood pressure control rates, FBG (fast blood glucose), hypokalemia and other adverse events between two groups after intervention.Results:
1333 participants were enrolled from 14 county hospitals in high-salt-intake area of China in 2014, with average sodium intake of 5893 mg per day. Baseline characteristics were well balanced between groups. In general, SBP/DBP reduction in T40 group was 12.5/8.0, 14.3/9.1 and 12.8/7.2 mmHg at 15 days, 30 days and 60 days of follow-up, respectively, while the counterparts in H25 group was 11.0/5.8, 13.6/7.1 and 11.5/5.3 mmHg, respectively. BP reduction in T40 group was greater than that in H25 group at 3 follow-up visits, but with only statistical significance for DBP. When controlled by gender, age, body mass index and baseline BP, subgroup analysis showed that DBP reduction was still higher in T40 group than that in H25 group (P < 0.001) regardless of the amount of urine sodium excretion and pulse pressure (PP). SBP reduction was positively related to increasing urine sodium and PP level for patients in both groups, but increased faster with increasing PP in H25 group than that in T40 group (P = 0.0238 for group*PP). Compared with T40, patients in H25 group showed more hypokalemia (T:0.4% vs H:4.5%, P < 0.001).Conclusions:
Telmisartan 40 mg showed better DBP lowering effect and less hypokalemia than HCTZ 25 mg among high sodium intake patients with mild to moderate hypertension. Effect superiority of HCTZ among patients with large pulse pressure might exist and needs further test.