Efficacy of 8-week monotherapy with losartan and its combination with hydrochlorothiazide in patients with hypertensive disease

Effect of 8 weeks of monotherapy with losartan (50 mg/day) on 24-hour blood pressure (BP) profile was studied in 28 patients with stage I-III hypertensive disease. in 16 patients who did not reach target blood pressure hydrochlorothiazide was added to losartan for 4 more weeks. Decreases of the following parameters were observed during monotherapy with losartan: diurnal BP (by 10.5/6.6+/-2.3/1.8 mm Hg p<0.001), nocturnal BP (by 10.3/5.8+/-2.5/2.0 mm Hg, p<0.01), pulse pressure (p<0.05), rate of morning diastolic BP elevation (p<0.002). BP and heart rate (HR) variability, degree of nocturnal lowering of systolic BP did not change. Trough/peak ratio was equal to 75 and 64.5% for systolic and diastolic BP, respectively, indicating that losartan taken once daily produced sufficient and steady hypotensive effect throughout 24 hours. Antihypertensive effect of therapy with losartan was observed in 50%, complete normalization of BP - in 33% of patients. In 16 patients hypotensive effect of losartan was insufficient during day and especially night time. After addition of hydrochlorothiazide nocturnal systolic BP was lowered by 11.2+/-2.5 mm Hg (p<0.02), diurnal systolic BP - by 7.0+/-3.7 mm Hg (p<0.1). Twenty four hour BP rhythm remained normal in dippers and improved in nondipppers and night peakers. BP and HR variability did not change. Target level of BP was achieved in 50% of patients with insufficient effect of losartan. Thus in nonresponders to losartan monotherapy addition of hydrochlorothiazide led to further lowering of BP and correction of 24-hour BP profile.