• 作者：Wille Oigman ; PhD¹ ; Marco Antô ; nio Mota Gomes ; BSc² ; Antô ; nio Carlos Pereira-Barretto ; PhD³ ; Rui Pó ; voa ; PhD⁴ ; Osvaldo Kohlmann ; PhD⁴ ; Joã ; o Carlos Rocha ; BSc⁵ ; Fernando Nobre ; PhD⁶ ; ^{fernando.nobre@uol.com.br}
• 关键词：ABPM ; fixed-dose combination ; hydrochlorothiazide ; hypertension treatment ; ramipril
• 刊名：Clinical Therapeutics
• 出版年：2013
• 出版时间：May, 2013
• 年：2013
• 卷：35
• 期：5
• 页码：702-710
• 全文大小：556 K

Background

Objective

This study was designed to compare the efficacy and safety of 2 ramipril and hydrochlorothiazide (HCTZ) fixed-dose combinations in patients with hypertension stage 1 or 2. Patients' blood pressure (BP) profiles were evaluated by using 24-hour ambulatory BP monitoring (ABPM).

Methods

This was a multicenter, prospective, randomized, open-label, parallel-group, noninferiority trial of adult patients (age ¡Ý18 years) with hypertension stage 1 or 2 and systolic blood pressure (SBP) within 140 to 179 mm Hg or diastolic blood pressure (DBP) 90 to 109 mm Hg. After a 2-week washout period, eligible patients were randomized to receive 1 of 2 ramipril/HCTZ fixed-dose combination formulations (5/25 mg/d) for 8 weeks. The primary end point was the difference in 24-hour ABPM SBP/DBP mean reductions between groups after 8 weeks of treatment. The secondary end points were the changes in daytime and nighttime ABPM and in office BP. Safety profile and tolerability assessments included monitoring of adverse events.

Results

A total of 102 patients with hypertension (54 in group A [test formulation] and 48 in group B [reference formulation]), aged 27 to 85 years, completed the 8-week treatment period. The decreases in SBP and DBP according to 24-hour ABPM from baseline to week 8 were significant and similar in both groups. SBP decreased from 149.1 to 133.0 mm Hg (?16.1 mm Hg) in group A and from 146.2 to 130.6 mm Hg in group B (?15.6 mm Hg) (P = 0.8537); DBP was reduced by 8.8 mm Hg in group A and by 8.5 mm Hg in group B (P = 0.8748). Because the lower 95 % CI limit for the difference between groups A and B of 3.96 mm Hg in SBP and 3.54 mm Hg in DBP was lower than that preestablished by the trial protocol (4 mm Hg), noninferiority of the test formulation was demonstrated compared with the reference formulation. For the secondary end points, there was no significant difference between groups in SBP and DBP during daytime or nighttime at the end of week 8. Office BP was significantly reduced in both treatment groups, with no significant differences between groups. The incidence of adverse events was 23.7 % in group A and 21.7 % in group B.

Conclusions

Both treatment options were well tolerated and equally reduced BP. The results support the conclusion that group A (new fixed-dose combination of ramipril/HCTZ) was noninferior to group B (reference medication in Brazil). ISRCTN Register: ISRCTN05051235.