Resumen

CAMMARATA, R et al. Efecto de la terapia combinada losartan e hidroclorotiazida en pacientes hipertensos "non dippers". AVFT [online]. 2004, vol.23, n.2, pp.150-158. ISSN 0798-0264.

With the aim of evaluating the effect of the combination of losartan plus hydrochlorothiazide (HCTZ) on the blood pressure and on nitric oxide (NO) production in "non-dipper" hypertensive patients, a prospective study was carried out in a group of 12 patients (6 of each sex), age: 52. 42 ± 2.52 years. Patients were with recent diagnosis of severe hypertension (SBP/DBP: 188 ± 5. 22/116. 17 ± 1.22 mmHg). Patients initially were evaluated and placed in placebo simple-blind fashion, by a maximum of 3 weeks, during that period weekly clinical examinations were carried out. They received the combination of losartan (100 mg) + HCTZ (25 mg), given once daily during 12 week-period. 24-hour ambulatory blood pressure monitoring and serum and 24-hour urinary NO levels were measured at the end of the placebo and active phases.In the placebo phase the mean of SBP/DBP 24-hour ambulatory blood pressure monitoring was 158.6 ± 4.67/ 102.2 ± 2.57 mmHg; the pulse pressure (PP) was 56.5 ± 2.70 mmHg and heart rate was: 74.8 ± 1.81 beat/min. The diurnal average was 159.3 ± 4.35 / 103.0 ± 2.50 mmHg; the nocturnal average: 154.9 ± 5, 33/98.9 ± 3.12 mmHg. The diurnal PP was 56.05 ± 3.05 mmHg and nocturnal PP was 55.89 ± 3.41 mmHg. After 3 months of combined therapy, the mean systolic/diastolic blood pressure was reduced to 140.3 ± 4.83 (p 0,001) / 90.9 ± 3.27 mmHg (p≤ 0,002); the PP reached 49.8 ± 2.46 mmHg (p≤ 0,006) and heart rate to 77.9 ± 2.17 b/min (p≤ 0,06). The diurnal systolic/diastolic BP was 135.01 ± 4.37 (p≤ 0,007) / 88.15 ± 3.10 (p≤ 0,002) mmHg. The nocturnal BP was of 140.9 ± 4.62 (p 0,035)/ 91.7 ± 3.24 (p 0,051) mmHg. The diurnal and nocturnal PP underwent reductions to 49.9 ± 2.36 (p≤0.007) and 50.33 ± 3.06 mmHg (p≤ 0,05) respectively. Nitric oxide changed from 40.89 ± 5.69 uM/L during placebo phase to 67.35 ± 6.96 uM/L (p≤ 0,007) at the end of the active phase; whereas the urinary concentration changed from 69.71 ± 3.68 uM/L to 79.64 ± 4.25 uM/L (p≤ 0,16); nitric oxide urinary clearance was not significantly modified by treatment from 1.14 ± 0.32 ml/min to 1.15 ± 0.14 ml/min (p≤ 0,9). Conclusions: fixed combination of losartan (100 mg) plus HCTZ (25 mg) reduced blood pressure in severe non-dipper hypertensive patients, without modifying non-dipper pattern. Fixed combination increase serum nitric oxide serum levels significantly. Treatment was well tolerated.

Palabras clave : Hypertension; Losartan; Hydrochlorothiazide; "Non-dippers"; Nitric oxide.