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

Research output: Contribution to journalArticle

9 Citations (Scopus)

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 (158.2/82.5 mmHg in the combination regimen, 157.3/84.4 mmHg in the increased ARB regimen, at baseline; 142.7/76.3 vs. 155.0/83.1 mmHg, respectively, P<0.001 for both, at 8 weeks; 139.6/74.6 vs. 149.1/78.1 mmHg, 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.

Original languageEnglish
Pages (from-to)2159-2166
Number of pages8
JournalCirculation Journal
Volume76
Issue number9
DOIs
Publication statusPublished - Sep 3 2012

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Amlodipine
Angiotensin Receptor Antagonists
Type 2 Diabetes Mellitus
Blood Pressure
Hypertension
Carotid Intima-Media Thickness
Glomerular Filtration Rate
Antihypertensive Agents

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Miyauchi, K., Yamazaki, T., Watada, H., Tanaka, Y., Kawamori, R., Imai, Y., ... Daida, H. (2012). Management of home blood pressure by amlodipine combined with angiotensin II receptor blocker in type 2 diabetes. Circulation Journal, 76(9), 2159-2166. https://doi.org/10.1253/circj.CJ-11-1406

Management of home blood pressure by amlodipine combined with angiotensin II receptor blocker in type 2 diabetes. / Miyauchi, Katsumi; Yamazaki, Tsutomu; Watada, Hirotaka; Tanaka, Yasushi; Kawamori, Ryuzo; Imai, Yutaka; Ikeda, Shunya; Kitagawa, Akira; Ono, Yasuhiro; Murayama, Fumio; Choi, Jong Bock; Suwa, Satoru; Hayashi, Dobun; Kishimoto, Junji; Daida, Hiroyuki.

In: Circulation Journal, Vol. 76, No. 9, 03.09.2012, p. 2159-2166.

Research output: Contribution to journalArticle

Miyauchi, K, Yamazaki, T, Watada, H, Tanaka, Y, Kawamori, R, Imai, Y, Ikeda, S, Kitagawa, A, Ono, Y, Murayama, F, Choi, JB, Suwa, S, Hayashi, D, Kishimoto, J & Daida, H 2012, 'Management of home blood pressure by amlodipine combined with angiotensin II receptor blocker in type 2 diabetes', Circulation Journal, vol. 76, no. 9, pp. 2159-2166. https://doi.org/10.1253/circj.CJ-11-1406
Miyauchi, Katsumi ; Yamazaki, Tsutomu ; Watada, Hirotaka ; Tanaka, Yasushi ; Kawamori, Ryuzo ; Imai, Yutaka ; Ikeda, Shunya ; Kitagawa, Akira ; Ono, Yasuhiro ; Murayama, Fumio ; Choi, Jong Bock ; Suwa, Satoru ; Hayashi, Dobun ; Kishimoto, Junji ; Daida, Hiroyuki. / Management of home blood pressure by amlodipine combined with angiotensin II receptor blocker in type 2 diabetes. In: Circulation Journal. 2012 ; Vol. 76, No. 9. pp. 2159-2166.
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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 (158.2/82.5 mmHg in the combination regimen, 157.3/84.4 mmHg in the increased ARB regimen, at baseline; 142.7/76.3 vs. 155.0/83.1 mmHg, respectively, P<0.001 for both, at 8 weeks; 139.6/74.6 vs. 149.1/78.1 mmHg, 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.",
author = "Katsumi Miyauchi and Tsutomu Yamazaki and Hirotaka Watada and Yasushi Tanaka and Ryuzo Kawamori and Yutaka Imai and Shunya Ikeda and Akira Kitagawa and Yasuhiro Ono and Fumio Murayama and Choi, {Jong Bock} and Satoru Suwa and Dobun Hayashi and Junji Kishimoto and Hiroyuki Daida",
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AU - Miyauchi, Katsumi

AU - Yamazaki, Tsutomu

AU - Watada, Hirotaka

AU - Tanaka, Yasushi

AU - Kawamori, Ryuzo

AU - Imai, Yutaka

AU - Ikeda, Shunya

AU - Kitagawa, Akira

AU - Ono, Yasuhiro

AU - Murayama, Fumio

AU - Choi, Jong Bock

AU - Suwa, Satoru

AU - Hayashi, Dobun

AU - Kishimoto, Junji

AU - Daida, Hiroyuki

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N2 - 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 (158.2/82.5 mmHg in the combination regimen, 157.3/84.4 mmHg in the increased ARB regimen, at baseline; 142.7/76.3 vs. 155.0/83.1 mmHg, respectively, P<0.001 for both, at 8 weeks; 139.6/74.6 vs. 149.1/78.1 mmHg, 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.

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