Management of Home Blood Pressure by Amlodipine Combined With Angiotensin II Receptor Blocker in Type 2 Diabetes

Katsumi Miyauchi; Tsutomu Yamazaki; Hirotaka Watada; Yasushi Tanaka; Ryuzo Kawamori; Yutaka Imai; Shunya Ikeda; Akira Kitagawa; Yasuhiro Ono; Fumio Murayama; Jong Bock Choi; Satoru Suwa; Dobun Hayashi; Junji Kishimoto; Hiroyuki Daida; for the ADVANCED-J investigators

doi:10.1253/circj.CJ-11-1406

Hypertension and Circulatory Control

Management of Home Blood Pressure by Amlodipine Combined With Angiotensin II Receptor Blocker in Type 2 Diabetes

Katsumi Miyauchi, Tsutomu Yamazaki, Hirotaka Watada, Yasushi Tanaka, Ryuzo Kawamori, Yutaka Imai, Shunya Ikeda, Akira Kitagawa, Yasuhiro Ono, Fumio Murayama, Jong Bock Choi, Satoru Suwa, Dobun Hayashi, Junji Kishimoto, Hiroyuki Daida, for the ADVANCED-J investigators

Author information

Katsumi Miyauchi
Department of Cardiology, Juntendo University School of Medicine
Tsutomu Yamazaki
Department of Clinical Epidemiology and Systems, Graduate School of Medicine, The University of Tokyo
Hirotaka Watada
Department of Medicine, Metabolism & Endocrinology, Juntendo University School of Medicine
Yasushi Tanaka
Department of Medicine, Metabolism and Endocrinology, St. Marianna University, School of Medicine
Ryuzo Kawamori
Sportology Center, Juntendo University Graduate School of Medicine
Yutaka Imai
Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School
Shunya Ikeda
Department of Pharmaceutical Sciences, International University of Health and Welfare
Akira Kitagawa
Kanazawa Medical Clinic
Yasuhiro Ono
Department of Medicine, Takagi Hospital
Fumio Murayama
Department of Respiratory Surgery, International University of Health and Welfare Atami Hospital
Jong Bock Choi
Department of Medicine, Metabolism & Endocrinology, Juntendo University School of Medicine
Satoru Suwa
Department of Cardiology, Juntendo University Shizuoka Hospital
Dobun Hayashi
Healthcare Center, Nippon Yusen Kaisya
Junji Kishimoto
Center for Clinical and Translational Research, Kyushu University Hospital
Hiroyuki Daida
Department of Cardiology, Juntendo University School of Medicine
for the ADVANCED-J investigators

Keywords: Angiotensin II receptor blocker, Calcium channel blocker, Home blood pressure, Hypertension, Type 2 diabetes

JOURNAL FREE ACCESS

2012 Volume 76 Issue 9 Pages 2159-2166

DOI https://doi.org/10.1253/circj.CJ-11-1406

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Abstract

Background: Angiotensin II receptor blocker (ARB) as a first-line drug for hypertension in diabetes often fails to control blood pressure adequately. The objective of the study was to evaluate the effect of amlodipine combined therapy on home blood pressure (HBP) useful for management of hypertension. Methods and Results: A total of 263 type 2 diabetes with hypertension refractory to standard dose of ARB were randomized to increased ARB regimen (n=132) or amlodipine combination regimen (n=131). The primary endpoint was change in morning HBP at 1 year. The combination regimen significantly lowered morning HBP than the increased ARB regimen (158.2/82.5mmHg in the combination regimen, 157.3/84.4mmHg in the increased ARB regimen, at baseline; 142.7/76.3 vs. 155.0/83.1mmHg, respectively, P<0.001 for both, at 8 weeks; 139.6/74.6 vs. 149.1/78.1mmHg, respectively, P<0.001 for systolic and P=0.010 for diastolic, at 1year). The combination regimen showed significantly higher rates of achieving target morning HBP at 8 weeks (11.3% vs. 2.7%, P=0.015). In the combination regimen, estimated glomerular filtration rate declined slower, and carotid intima-media thickness decreased in contrast to the increased ARB regimen. Conclusions: In type 2 diabetes patients with hypertension refractory to standard dose of ARB, the amlodipine combination regimen provides superior antihypertensive effect on HBP to the increased ARB regimen, and beneficial effects on reducing risks of cardiovascular events. (Circ J 2012; 76: 2159–2166)

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