Morning hypertension is an independent risk for cerebrovascular and cardiovascular events. Although the incidence of morning hypertension increases with age, treatment of morning hypertension has not been established particularly in late-elderly patients. Among various combinations, ARB combined with a small dose of thiazide diuretic is desirable because the two drugs have complementary mechanisms of action, and effectively reduce BP. Thus, we investigated the safety and efficacy of ARB/hydrochlorothiazide (HCTZ) combination in controlling morning hypertension in the very elderly.Design and Method:
This is a subanalysis of the Morning Hypertension and Angiotensin Receptor Blocker/Hydrochlorothiazide Combination Therapy (MAPPY) study, which compared the effects of a combination of 50-mg losartan/12.5-mg HCTZ (Combination) and 100-mg losartan (High ARB) on morning SBP levels after 3-month treatment in on-treatment hypertensive patients with morning SBP greater than 135/85 mmHg on home BP self-measurement. Patients were allocated to very elderly group (≥ 75 years) and young/elderly group (< 75 years).Results:
Effects of 3-month Combination therapy and High ARB therapy were summarized in Table (*P < 0.05 and **P < 0.01 vs. baseline; #P < 0.05 and ##P < 0.01 vs. High ARB group). More than 98% of patients in all groups showed the adherence to medications of 80% or more. The incidence of adverse events of both treatments was similar in both groups.Conclusions:
In the elderly patients, ARB/HTCZ combination induced further morning SBP reduction and greater target achievement ratio of morning BP (<135/85 mmHg) than high-dose ARB, to the similar levels seen in the young/elderly patients. And, ARB/HTCZ combination was safe and tolerable in either age group.