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Monotherapy Versus Dual Therapy for Initial Treatment for Hypertension

2014-07-24 14:11:15 | BioPortfolio

Summary

To test whether the current custom of initiating treatment for hypertension with a single drug is less effective in the short-term than initial combination therapy, and results in the eventual need for comparatively more antihypertensive drug therapy.

Description

To determine if patients randomised to more aggressive (combination therapy) treatment for the initial treatment of hypertension have better blood pressure control compared to those randomised to less aggressive (monotherapy) treatment despite subsequent add-on treatment being similar in each group. This will test the hypothesis that monotherapy patients 'never catch up' with combination therapy patients.

1. To determine if this 'never catch-up' phenomenon of improved BP control persists for at least one year.

2. To understand the underlying mechanism of improved BP control; specifically:

1. To determine if it is due to haemodynamic compensation, such as increased sodium retention and volume expansion.

2. To determine if it is due to increased peripheral resistance.

3. To understand the predictors of BP control i.e. age, baseline renin status, sodium status and plasma volume.

4. To validate the National Institute for Clinical Excellence / British Hypertension Society joint guideline ACD algorithm by comparing BP control in the monotherapy crossover arm of phase 1 and to correlate this with age (≤ 55 or > 55y), and baseline characteristics such as renin.

5. To determine the safety and tolerability of a strategy of prescribing combination therapy as the initial step versus monotherapy as the initial step.

Study Design

Allocation: Randomized, Control: Active Control, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Investigator), Primary Purpose: Treatment

Conditions

Resistant Hypertension

Intervention

Losartan and hydrochlorothiazide, Hydrochlorothiazide switched over with Losartan at 8 weeks

Location

Professor Morris Brown
Cambridge
Cambridgeshire
United Kingdom
CB22QQ

Status

Not yet recruiting

Source

University of Cambridge

Results (where available)

View Results

Links

Published on BioPortfolio: 2014-07-24T14:11:15-0400

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PubMed Articles [3145 Associated PubMed Articles listed on BioPortfolio]

The current position of hydrochlorothiazide among thiazide and thiazide-like diuretics.

Thiazide and thiazide-like diuretics are an important group of drugs used in the treatment of essential arterial hyper-tension. While their beneficial therapeutic effect in monotherapy is evident, the...

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Medical and Biotech [MESH] Definitions

An antagonist of ANGIOTENSIN TYPE 1 RECEPTOR with antihypertensive activity due to the reduced pressor effect of ANGIOTENSIN II.

A thiazide diuretic with properties similar to those of HYDROCHLOROTHIAZIDE. (From Martindale, The Extra Pharmacopoeia, 30th ed, p830)

A thiazide diuretic with actions and uses similar to those of HYDROCHLOROTHIAZIDE. (From Martindale, The Extra Pharmacopoeia, 30th ed, p826)

A thiazide diuretic with properties similar to those of HYDROCHLOROTHIAZIDE. (From Martindale, The Extra Pharmacopoeia, 30th ed, p825)

A thiazide diuretic with actions and uses similar to those of HYDROCHLOROTHIAZIDE. (From Martindale, The Extra Pharmacopoeia, 30th ed, p822)

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