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Addition of Amlodipine to Angiotensin Blockers Improves Ability Blood Pressure Treatment in Diabetics: Presented at ASH

By Ed Susman

NEW YORK, N.Y. -- May 22, 2006 -- Patients with diabetes and hypertension can reach their blood pressure goals more effectively if they add amlodipine to either quinapril or losartan monotherapy, researchers said here at the 21^st annual scientific meeting and exposition of the American Society of Hypertension (ASH).

The Amlodipine Diabetic Hypertension Efficacy Response Evaluation Trial (ADHT) compared the efficacy of combination treatment and monotherapy in diabetic patients with high blood pressure. The clear winner was the dual-drug treatment.

"Clearly 2 drugs are better than 1," said Joel Neutel, MD, medical director, Orange County Heart Institute and Research Center, Orange, California. "But that still means the vast majority of people still are not reaching their goal. With many of these people we will need 3 or 4 drugs."

Individuals who do not have other medical or health conditions, such as diabetes or heart failure, the blood pressure goal is to lower blood pressure to <140 mm Hg systolic and 90 mm Hg diastolic. For people with diabetes the blood pressure goal is <130 mm Hg systolic and 80 mm Hg diastolic.

In Dr. Neutel's multicenter, randomized, double-blind, double-dummy study, there were 96 people in the quinapril/amlodipine arm, 103 were on quinapril/placebo, 115 were on losartan/amlodipine, and 97 were on losartan/placebo. All had diabetes and hypertension.

Patients were about 58 years old and about 55% were men; 70% were white. The trial ran for 20 weeks. The main inclusion criteria was a diagnosis of diabetes and blood pressure levels of 140 to 170 mm Hg systolic and/or 90 to 110 mm Hg diastolic. Patients were not on any antihypertensive therapy prior to entering the trial.

Of these 411 hard-to-treat patients, 27.5% were able to reach blood pressure levels below 130/80 mm Hg. Only 12.5% of those on a single drug reached the goal.

There were little differences in adverse events in any of the treatment arms.

"Amlodipine is a safe, well tolerated and efficacious add-on antihypertensive treatment in diabetic hypertensive patients initiated on therapy with quinapril or losartan," Dr. Neutel concluded.

Dr. Neutel said his choice for a third drug in these patients would likely be a diuretic.


[Presentation title: Addition of Amlodipine to the Antihypertensive Regimen of Diabetic Hypertensives Initiated With Quinapril or Losartan Monotherapy More Than Doubles Blood Pressure Goal Attainment: Results From the Amlodipine Diabetic Hypertension Efficacy Response Evaluation Trial (ADHT). Late Breaker]

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