Clinical InvestigationCombination Therapy of Calcium Channel Blocker and Angiotensin II Receptor Blocker Reduces Augmentation Index in Hypertensive Patients
Section snippets
Study Subjects
The subjects of this study were hypertensive patients who had visited the outpatient clinic of the Division of Cardiology, Sumitomo Besshi Hospital, Niihama, Japan, and had not achieved their BP goal of 140/90 mm Hg after receiving ARB monotherapy. Exclusion criteria were as follows: secondary hypertension, ischemic heart disease, acute coronary syndrome, congestive heart failure (New York Heart Association class II or greater) or stroke within 6 months of study initiation, impaired renal
Patients
Originally, 43 patients were randomized into AZ and TCM groups. Six patients did not undergo follow-up and were, therefore, excluded from the study. As a result, data on 37 patients (18 in the AZ group and 19 in the TCM group) were analyzed in this study. At the time of enrollment, all the patients were being treated for hypertension with several ARBs (Table 1). The type of ARB used in this study did not differ between the groups. Diabetic patients were included in both the groups, and only 1
DISCUSSION
This study indicated that combination treatment with azelnidipine added to ARB had more effect on reducing the AI, especially in elderly patients, than with a diuretic, trichlormethiazide. The hsCRP and serum ADMA in the AZ group were significantly decreased, and the reduction in AI was shown to be correlated with the change in the serum ADMA, an inhibitor of NO production. These findings suggest that combination therapy with an ARB and azelnidipine may not only be more beneficial for BP
ACKNOWLEDGMENTS
The authors thank the members of the SKY research group (Sumitomo Besshi Hospital, Kagawa Prefectural Central Hospital, and Yashima General Hospital) for stimulating discussions.
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This work was supported in part by the Japan Society for the Promotion of Science grant-in-aid for Scientific Research 20790531 (to TM).