Published in:
01-04-2019 | Original Article
Randomized trial of an increased dose of calcium channel blocker or angiotensin II type 1 receptor blocker as an add-on intensive depressor therapy in type 2 diabetes mellitus patients with uncontrolled essential hypertension: the ACADEMIE Study
Authors:
Satoshi Imaizumi, Yuhei Shiga, Masahiro Ogawa, Hideto Sako, Yoshihisa Nagata, Akira Matsunaga, Tetsuro Shirotani, Fumihiro Hoshino, Eiji Yahiro, Yuko Uehara, Natsumi Morito, Hiroyuki Tanigawa, Dai Shimono, Mikio Fukushima, Hidekazu Sugihara, Kenji Norimatsu, Takaaki Kusumoto, Keijiro Saku, Shin-ichiro Miura, ACADEMIE Study Investigators
Published in:
Heart and Vessels
|
Issue 4/2019
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Abstract
There is a lack of data on how to treat hypertensive patients with diabetes when treatment with medium doses of calcium channel blocker and angiotensin II type 1 receptor blocker (ARB) is insufficient to achieve the target blood pressure (BP). A total of 121 participants with type 2 diabetes and uncontrolled essential hypertension, who were receiving medium doses of amlodipine (5 mg/day) and ARB, were enrolled. Participants were randomized to receive either a high dose of amlodipine (10 mg/day) plus a medium dose of ARB (high-AML) or a medium dose of amlodipine (5 mg/day) plus a high dose of ARB (high-ARB). The depressor effects of these two regimens were monitored using a telemonitoring home BP-measuring system. Fifty-four patients were excluded after an observation period, and the remaining 67 eligible participants were randomized into the two groups; 42 which had a record of their home BP for analysis. The change in morning home systolic and diastolic BP was greater in the high-AML than in the high-ARB (systolic BP; − 7.9 mmHg vs. + 2.7 mmHg; p = 0.0002, diastolic BP; − 3.9 mmHg vs. + 0.6 mmHg; p = 0.0007). In addition, the home systolic and diastolic BP before going to bed and office systolic BP were significantly reduced from week 0 only in the high-AML. An increased dose of amlodipine, but not ARB, reduced home morning BP in hypertensive patients with type 2 diabetes who were already receiving combination therapy with medium doses of amlodipine and ARB.