Valsartan addition to amlodipine is more effective than losartan addition in hypertensive patients inadequately controlled by amlodipine

Introduction: This study evaluated the effects on blood pressure (BP) of valsartan 160 mg or losartan 100 mg addition to amlodipine 5 mg in hypertensive patients. Methods: 221 patients with inadequately controlled BP (DBP ≥ 90 mmHg) after 4 weeks of treatment with amlodipine 5 mg were randomized to receive losartan/amlodipine combination therapy or valsartan/amlodipine combination therapy for 4 weeks in a cross-over study design. At the end of the wash-out period and of each treatment period, clinic and ambulatory BP measurements were recorded. Results: 166 patients completed the study. Both combination treatments induced a greater ambulatory BP reduction than did monotherapy. However, the further mean reductions in BP versus monotherapy were significantly greater with the valsartan/amlodipine combination (SBP/DBP: −7.9 ± 3.4/−6.5 ± 2.6 mmHg for 24-hour, −8.0 ± 3.4/−6.6 ± 2.7 mmHg for daytime; −7.7 ± 3.3/−6.4 ± 2.7 mmHg for nighttime) than with the losartan/amlodipine combination (SBP/DBP: −5.5 ± 2.8/−4.2 ± 2.1 mmHg for 24-hour, −5.7 ± 2.9/−4.4 ± 2.2 mmHg for daytime; −4.8 ± 2.8/−3.7 ± 2.2 mmHg for nighttime; P < 0.01 vs valsartan/amlodipine). The incidence of adverse events with valsartan/amlodipine (8%) and losartan/amlodipine (9%) was lower than that observed with amlodipine monotherapy (17%; P < 0.05 vs combinations). Conclusion: Valsartan 160 mg plus amlodipine 5 mg produced greater BP reductions than losartan 100 mg plus amlodipine 5 mg.