J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 9, Number 2, February 2017, pages 98-103

Efficacy and Safety of Combination Therapy Consisting of Angiotensin II Type 1 Receptor Blocker, Calcium Channel Blocker and Hydrochlorothiazide in Patients With Hypertension

Figure 1. Changes in SBP, DBP and PR in all patients (n = 32) and in the H-ARB/CCB (n = 20) and M-ARB/CCB/HCTZ (n = 12) groups. *P < 0.05 vs. 0 months (M).

Figure 2. Percentages (%) of patients who reached the target BP at 0 and 3 months in all patients and in the H-ARB/CCB and M-ARB/CCB/HTCZ groups. *P < 0.05 vs. 0 months.

Figure 3. ΔSBP and ΔDBP in all patients (n = 32) and in the H-ARB/CCB (n = 20) and M-ARB/CCB/HCTZ (n = 12) groups over 3 months. Δ indicates the value at 3 months minus the value at 0 months. NS: not significant.

**Table 1.** Baseline Patient Characteristics in All Patients and in the H-ARB/CCB and M-ARB/CCB/HTCZ Groups
	All patients (n = 32)	H-ARB/CCB (n = 20)	M-ARB/CCB/HTCZ (n =12)
Continuous variables are expressed as mean ± SD. BMI: body mass index; WC: waist circumference; DL: dyslipidemia; LDL-C: low-density lipoprotein cholesterol; HDL-C: high-density lipoprotein cholesterol; TG: triglyceride; DM: diabetes mellitus; HbA1c: hemoglobin A1c; HU: hyperuricemia; UA: uric acid; CAD: coronary artery disease.
Age, years	69 ± 15	69 ± 16	68 ± 13
Gender (male), n (%)	16 (50)	11 (55)	5 (42)
Smoking, n (%)	11 (34)	8 (40)	3 (25)
BMI, kg/m²	23.9 ± 4.3	23.8 ± 4.6	24.0 ± 3.9
WC, cm	85.7 ± 10.2	86.1 ± 11.1	87.0 ± 8.9
DL, n (%)	18 (56)	10 (50)	8 (67)
LDL-C, mg/dL	104 ± 32	106 ± 35	100 ± 27
HDL-C, mg/dL	52 ± 12	51 ± 13	52 ± 10
TG, mg/dL	145 ± 92	138 ± 92	155 ± 95
DM, n (%)	5 (16)	3 (15)	2 (17)
Fasting glucose, mg/dL	102 ± 29	102 ± 35	103 ± 16
HbA1c, %	5.3 ± 0.9	5.4 ± 1.0	5.2 ± 0.5
HU, n (%)	6 (19)	4 (20)	2 (12)
UA, mg/dL	5.4 ± 1.3	5.3 ± 1.2	5.7 ± 1.4
CAD, n (%)	4 (13)	4 (20)	0 (0)

Table 1. Baseline Patient Characteristics in All Patients and in the H-ARB/CCB and M-ARB/CCB/HTCZ Groups

All patients (n = 32)

H-ARB/CCB (n = 20)

M-ARB/CCB/HTCZ (n =12)

Continuous variables are expressed as mean ± SD. BMI: body mass index; WC: waist circumference; DL: dyslipidemia; LDL-C: low-density lipoprotein cholesterol; HDL-C: high-density lipoprotein cholesterol; TG: triglyceride; DM: diabetes mellitus; HbA1c: hemoglobin A1c; HU: hyperuricemia; UA: uric acid; CAD: coronary artery disease.

Age, years

69 ± 15

69 ± 16

68 ± 13

Gender (male), n (%)

16 (50)

11 (55)

5 (42)

Smoking, n (%)

11 (34)

8 (40)

3 (25)

BMI, kg/m²

23.9 ± 4.3

23.8 ± 4.6

24.0 ± 3.9

WC, cm

85.7 ± 10.2

86.1 ± 11.1

87.0 ± 8.9

DL, n (%)

18 (56)

10 (50)

8 (67)

LDL-C, mg/dL

104 ± 32

106 ± 35

100 ± 27

HDL-C, mg/dL

52 ± 12

51 ± 13

52 ± 10

TG, mg/dL

145 ± 92

138 ± 92

155 ± 95

DM, n (%)

5 (16)

3 (15)

2 (17)

Fasting glucose, mg/dL

102 ± 29

102 ± 35

103 ± 16

HbA1c, %

5.3 ± 0.9

5.4 ± 1.0

5.2 ± 0.5

HU, n (%)

6 (19)

4 (20)

2 (12)

UA, mg/dL

5.4 ± 1.3

5.3 ± 1.2

5.7 ± 1.4

CAD, n (%)

4 (13)

4 (20)

0 (0)

**Table 2.** Medications in All Patients and in the H-ARB/CCB and M-ARB/CCB/HTCZ Groups
	All patients (n = 32)	H-ARB/CCB (n = 20)	M-ARB/CCB/HTCZ (n = 12)
CCBs: calcium channel blockers; ARBs: angiotensin II receptor blockers; HCTZ: hydrochlorothiazide.
Medication use
CCBs
Nifedipine 40 mg, n (%)	25 (78)	14 (70)	11 (92)
Amlodipine 5 mg, n (%)	7 (22)	6 (30)	1 (8)
β-blocker, n (%)	1 (3)	1 (5)	0 (0)
α-blocker, n (%)	1 (3)	1 (5)	0 (0)
Medication use before changeover
ARBs, n (%)	20 (63)	20 (100)	0 (0)
Telmisartan 80 mg, n (%)	12 (38)	12 (60)	0 (0)
Olmesartan 40 mg, n (%)	6 (19)	6 (30)	0 (0)
Valsartan 160 mg, n (%)	2 (6)	2 (10)	0 (0)
Losartan 50 mg + HCTZ 12.5 mg, n (%)	12 (38)	0 (0)	12 (100)

Table 2. Medications in All Patients and in the H-ARB/CCB and M-ARB/CCB/HTCZ Groups

All patients (n = 32)

H-ARB/CCB (n = 20)

M-ARB/CCB/HTCZ (n = 12)

CCBs: calcium channel blockers; ARBs: angiotensin II receptor blockers; HCTZ: hydrochlorothiazide.

Medication use

CCBs

Nifedipine 40 mg, n (%)

25 (78)

14 (70)

11 (92)

Amlodipine 5 mg, n (%)

7 (22)

6 (30)

1 (8)

β-blocker, n (%)

1 (3)

1 (5)

0 (0)

α-blocker, n (%)

1 (3)

1 (5)

0 (0)

Medication use before changeover

ARBs, n (%)

20 (63)

20 (100)

0 (0)

Telmisartan 80 mg, n (%)

12 (38)

12 (60)

0 (0)

Olmesartan 40 mg, n (%)

6 (19)

6 (30)

0 (0)

Valsartan 160 mg, n (%)

2 (6)

2 (10)

0 (0)

Losartan 50 mg + HCTZ 12.5 mg, n (%)

12 (38)

0 (0)

12 (100)

**Table 3.** Biochemical Parameters at 0 and 3 Months in All Patients and in the H-ARB/CCB and M-ARB/CCB/HTCZ Groups
	All patients (n = 32)	H-ARB/CCB (n = 20)	M-ARB/CCB/HTCZ (n = 12)
BUN: blood urea nitrogen; Cr: creatinine; eGFR: estimated glomerular filtration rate; UA: uric acid; Na: sodium; K: potassium; TG: triglyceride; LDL-C: low-density lipoprotein cholesterol; HDL-C: high-density lipoprotein cholesterol; FPG: fast plasma glucose; HbA1c: hemoglobin A1c; BNP: brain natriuretic peptide. *P < 0.05 vs. 0 months.
BUN, mg/dL	18 ± 11	20 ± 12	17 ± 12	21 ± 15	20 ± 7	19 ± 6
Cr, mg/dL	0.9 ± 0.4	1.0 ± 0.4	0.9 ± 0.5	1.0 ± 0.4	1.0 ± 0.4	0.9 ± 0.4
eGFR, mL/min/1.73 m²	63 ± 21	61 ± 23	67 ± 22	63 ± 25	56 ± 18	60 ± 20
UA, mg/dL	5.4 ± 1.3	6.0 ± 1.3*	5.3 ± 1.2	6.0 ± 1.3*	5.7 ± 1.4	6.2 ± 1.3
Na, mEq/L	141 ± 2	140 ± 3	141 ± 2	140 ± 3	140 ± 2	140 ± 3
K, mEq/L	4.0 ± 0.5	4.1 ± 0.7	4.0 ± 0.6	4.2 ± 0.7	4.0 ± 0.4	4.1 ± 0.6
TG, mg/dL	145 ± 92	135 ± 72	138 ± 92	120 ± 61	155 ± 95	159 ± 84
LDL-C, mg/dL	104 ± 32	102 ± 30	106 ± 35	104 ± 34	127 ± 46	129 ± 31
HDL-C, mg/dL	52 ± 12	56 ± 16	51 ± 13	58 ± 18	52 ± 10	52 ± 10
FPG, mg/dL	102 ± 229	116 ± 81	102 ± 35	122 ± 10	103 ± 16	106 ± 24
HbA1c, %	5.3 ± 0.9	5.5 ± 0.8*	5.4 ± 1.0	5.5 ± 1.0	5.2 ± 0.5	5.4 ± 0.5
BNP, pg/mL	67 ± 92	55 ± 72	66 ± 70	66 ± 87	70 ± 124	36 ± 28

Table 3. Biochemical Parameters at 0 and 3 Months in All Patients and in the H-ARB/CCB and M-ARB/CCB/HTCZ Groups

All patients (n = 32)

H-ARB/CCB (n = 20)

M-ARB/CCB/HTCZ (n = 12)

0 months

3 months

0 months

3 months

0 months

3 months

BUN: blood urea nitrogen; Cr: creatinine; eGFR: estimated glomerular filtration rate; UA: uric acid; Na: sodium; K: potassium; TG: triglyceride; LDL-C: low-density lipoprotein cholesterol; HDL-C: high-density lipoprotein cholesterol; FPG: fast plasma glucose; HbA1c: hemoglobin A1c; BNP: brain natriuretic peptide. *P < 0.05 vs. 0 months.

BUN, mg/dL

18 ± 11

20 ± 12

17 ± 12

21 ± 15

20 ± 7

19 ± 6

Cr, mg/dL

0.9 ± 0.4

1.0 ± 0.4

0.9 ± 0.5

1.0 ± 0.4

0.9 ± 0.4

eGFR, mL/min/1.73 m²

63 ± 21

61 ± 23

67 ± 22

63 ± 25

56 ± 18

60 ± 20

UA, mg/dL

5.4 ± 1.3

6.0 ± 1.3*

5.3 ± 1.2

6.0 ± 1.3*

5.7 ± 1.4

6.2 ± 1.3

Na, mEq/L

141 ± 2

140 ± 3

141 ± 2

140 ± 3

140 ± 2

140 ± 3

K, mEq/L

4.0 ± 0.5

4.1 ± 0.7

4.0 ± 0.6

4.2 ± 0.7

4.0 ± 0.4

4.1 ± 0.6

TG, mg/dL

145 ± 92

135 ± 72

138 ± 92

120 ± 61

155 ± 95

159 ± 84

LDL-C, mg/dL

104 ± 32

102 ± 30

106 ± 35

104 ± 34

127 ± 46

129 ± 31

HDL-C, mg/dL

52 ± 12

56 ± 16

51 ± 13

58 ± 18

52 ± 10

FPG, mg/dL

102 ± 229

116 ± 81

102 ± 35

122 ± 10

103 ± 16

106 ± 24

HbA1c, %

5.3 ± 0.9

5.5 ± 0.8*

5.4 ± 1.0

5.5 ± 1.0

5.2 ± 0.5

5.4 ± 0.5

BNP, pg/mL

67 ± 92

55 ± 72

66 ± 70

66 ± 87

70 ± 124

36 ± 28