Amlodipine versus losartan
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Comparative Analysis of Amlodipine and Losartan in Hypertension Management
Efficacy in Blood Pressure Control
Amlodipine/Losartan Combination vs. Losartan Monotherapy
A study conducted on Chinese patients with inadequately controlled hypertension after losartan treatment demonstrated that a single-pill combination of amlodipine and losartan (AML/LOS) was significantly more effective in reducing both systolic and diastolic blood pressure compared to losartan alone. The AML/LOS group showed a greater reduction in sitting diastolic blood pressure (sitDBP) and sitting systolic blood pressure (sitSBP) at both 4 and 8 weeks of treatment. Additionally, the blood pressure target achievement rates were higher in the AML/LOS group at both time points.
Losartan/Amlodipine vs. Losartan/Hydrochlorothiazide
In another study, the combination of losartan and amlodipine (L/A) was compared to losartan and hydrochlorothiazide (L/H) in hypertensive patients. The L/A combination showed superior efficacy in reducing 24-hour brachial and central blood pressure, particularly in patients with advanced arterial stiffness.
Renal Effects
Proteinuria and Renal Hemodynamics
Losartan has been shown to significantly reduce proteinuria in patients with non-diabetic nephropathy and chronic kidney disease (CKD), whereas amlodipine did not exhibit the same effect. This was evident in both short-term and long-term studies, where losartan consistently reduced urinary protein excretion, contributing to its renoprotective benefits . Additionally, losartan was found to reduce the plasma levels of TGF-beta(1), a cytokine involved in fibrosis, which amlodipine did not affect.
Renal Transplant Recipients
In renal transplant patients, losartan maintained glomerular filtration rate (GFR) and reduced estimated glomerular hydrostatic pressure and filtration fraction, whereas amlodipine increased GFR through an increase in these parameters. This suggests that losartan may be more beneficial in managing renal hemodynamics in this patient population.
Tolerability and Quality of Life
Adverse Events and Drug Withdrawal
A comparative study on drug tolerability indicated that amlodipine was associated with a higher incidence of adverse events such as swollen ankles and drug-related discomfort, leading to a higher withdrawal rate from therapy. In contrast, losartan was better tolerated and associated with fewer adverse events.
Psychological Well-Being
The Psychological General Well-Being (PGWB) index showed improvements in some domains for patients treated with losartan, whereas it remained unchanged for those treated with amlodipine. This suggests a potential benefit of losartan in enhancing the quality of life for hypertensive patients.
Special Populations
Elderly Oncologic Patients
In elderly cancer patients with hypertension, losartan was more effective than amlodipine in managing both hypertension and hyperuricemia, particularly after chemotherapy. Losartan showed significant improvements in urinary uric acid excretion and glomerular filtration rate (GFR) compared to amlodipine.
Children with Alport Syndrome
In children with Alport syndrome, losartan significantly reduced proteinuria compared to amlodipine, indicating its potential benefit in managing proteinuria in pediatric patients with this condition.
Conclusion
Both amlodipine and losartan are effective in lowering blood pressure, but they exhibit different profiles in terms of renal protection, tolerability, and specific patient populations. Losartan appears to offer additional benefits in reducing proteinuria and managing renal hemodynamics, making it a preferable option for patients with CKD or those requiring renal protection. Amlodipine, while effective in blood pressure control, may be associated with higher adverse event rates and less impact on renal parameters. Therefore, the choice between these medications should be tailored to the individual patient's needs and underlying conditions.
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