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Abstract
BACKGROUND AND OBJECTIVES: There is evidence available from randomized control trials about the additive effects of combination regimens that are mainly based on diuretics and beta-blockers or ACE inhibitors. Yet there are some arguments about the effect of the combination of calcium channel blockers (CCBs) and diuretics. We aimed to study the blood pressure-lowering effects of lercanidipine, indapamide or a combination therapy on the home blood pressure (HBP) and the 24-hour ambulatory blood pressure (ABP), and we wanted to examine the agreement with using these two methods.
SUBJECTS AND METHODS: 70 patients participated in this randomized open crossover design study. The treatments in each phase were 10 mg lercanidipine (L) and 1 mg indapamide (I), separately and also in combination (L+I). Each patient had their HBP checked twice during each phase and the 24h ABP was checked in two of the 3 phases. We also measured the agreement between the HBP and ABP by using a Bland-Altman plot.
RESULTS: 58 patients (mean age: 49±9 (31-71) years; 37 males and 21 females) completed the study. The blood pressure was significantly reduced during all the active treatments compared with the baseline (L: 160.2±12/100.3±9 mmHg, I; 130.5±9.3/86.0±8.1 mmHg, 129.2±12.9/83.9±11.1 mmHg, L+I:124.9±10.9/81.3±8.5 mmHg, p<.000) and the BP for the combination therapy was also significantly less than those BPs for both the other monotherapies (L+I vs. L: p<.002, L+I vs. I: p<.01) by measuring the 24h ABP. The Bland-Altman plot showed±25 mmHg for the limit of agreement between both measurement methods.
CONCLUSION: CCB and diuretics were effective agents for treating hypertensive patients. As a combination therapy, the effects on blood pressure are additive. Poor agreement of the blood pressures with using the two measurement methods was observed.
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