Antihypertensive and metabolic effects of Angiotensin receptor blocker/diuretic combination therapy in obese, hypertensive African American and white patients.

A clinical trial showed comparable blood pressure (BP) lowering by valsartan/hydrochlorothiazide and amlodipine/hydrochlorothiazide in obese hypertensives. Relative to amlodipine/hydrochlorothiazide, valsartan/hydrochlorothiazide reduced the hyperglycemic response to glucose challenge. An objective of this post-hoc analysis was to determine whether this benefit extended to African Americans and Caucasians. Treatments (valsartan/hydrochlorothiazide 160/12.5 mg force-titrated to valsartan/hydrochlorothiazide 320/25 mg at Week 4 or hydrochlorothiazide 12.5 mg force-titrated to hydrochlorothiazide 25 mg at Week 4 with amlodipine 5 mg and 10 mg added at Weeks 8 and 12, respectively) were administered once daily. Both treatments reduced clinic BP from baseline to all visits (p<0.0001), regardless of race/ethnicity (126 African Americans, 212 Caucasians). In African Americans, there were no significant between-treatment differences in clinic or ambulatory BP lowering at Weeks 8 or 16. Caucasians responded better to valsartan/hydrochlorothiazide. In both racial/ethnic subgroups, the addition of valsartan but not amlodipine mitigated the hyperglycemic response to hydrochlorothiazide through enhanced insulin secretion. Valsartan/hydrochlorothiazide was as effective as amlodipine/hydrochlorothiazide in reducing BP in obese, hypertensive African Americans, and better than amlodipine/hydrochlorothiazide in Caucasians. In both racial/ethnic subgroups, addition of valsartan to hydrochlorothiazide reduced the negative metabolic effects associated with thiazide therapy.