Losartan amlodipine
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Comparative Efficacy of Losartan and Amlodipine in Hypertension and Kidney Disease
Renoprotective Effects in Chronic Kidney Disease (CKD)
Losartan vs. Amlodipine in Proteinuria Reduction
In patients with chronic kidney disease (CKD) and hypertension, losartan has shown a significant reduction in proteinuria compared to amlodipine. A 12-month study demonstrated that losartan reduced 24-hour urinary protein excretion by 20.7%, 35.2%, and 35.8% at 3, 6, and 12 months, respectively, while amlodipine did not affect proteinuria levels . This suggests that losartan's renoprotective benefits extend beyond blood pressure control.
Impact on Renal Hemodynamics and TGF-beta(1) Levels
In renal transplant recipients, losartan and amlodipine had different effects on renal hemodynamics and TGF-beta(1) plasma levels. Losartan maintained glomerular filtration rate (GFR) and significantly reduced TGF-beta(1) levels by approximately 50%, whereas amlodipine increased GFR but did not affect TGF-beta(1) levels . This indicates that losartan may offer additional benefits in managing chronic allograft nephropathy by reducing fibrotic processes.
Blood Pressure Control and Arterial Stiffness
Combination Therapy with Losartan and Amlodipine
A study comparing losartan/amlodipine (L/A) combination therapy to losartan/hydrochlorothiazide (L/H) found that L/A was more effective in reducing 24-hour brachial and central blood pressure, particularly in patients with advanced arterial stiffness . This highlights the superior efficacy of the L/A combination in managing hypertension in patients with arterial stiffness.
Single-Pill Combination for Inadequately Controlled Hypertension
In Chinese patients with inadequately controlled hypertension, a single-pill combination of amlodipine and losartan was more effective than losartan monotherapy. The combination significantly reduced both systolic and diastolic blood pressure and had higher blood pressure target achievement rates at 4 and 8 weeks . This suggests that the combination therapy is a potent option for patients not responding adequately to losartan alone.
Safety and Tolerability
Adverse Events and Quality of Life
Losartan and amlodipine were both effective in lowering blood pressure, but losartan had a better tolerability profile. A study found that amlodipine was associated with a higher incidence of adverse events such as swollen ankles, while losartan was more likely to cause dizziness upon standing. Additionally, losartan treatment was associated with improvements in the Psychological General Well-Being (PGWB) index, indicating better overall quality of life .
Elderly Oncologic Patients
In elderly cancer patients with hypertension, losartan was more effective than amlodipine in managing both hypertension and hyperuricemia. Losartan significantly improved urinary uric acid excretion and glomerular filtration rate (GFR) compared to amlodipine, making it a preferable option for this patient population .
Conclusion
Losartan and amlodipine are both effective antihypertensive agents, but losartan offers additional renoprotective benefits, particularly in reducing proteinuria and TGF-beta(1) levels. Combination therapies involving losartan and amlodipine provide superior blood pressure control, especially in patients with arterial stiffness or inadequately controlled hypertension. Losartan also has a better safety and tolerability profile, making it a suitable choice for a broader range of patients, including those with CKD, renal transplants, and elderly oncologic patients.
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Most relevant research papers on this topic
Renal effects of losartan and amlodipine in hypertensive patients with non-diabetic nephropathy.
Losartan, but not amlodipine, decreased albumin excretion in hypertensive patients with non-diabetic nephropathy.
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Efficacy and safety of losartan in children with Alport syndrome--results from a subgroup analysis of a prospective, randomized, placebo- or amlodipine-controlled trial.
Losartan significantly reduced proteinuria and was well-tolerated after 12 weeks of treatment in children aged 1-17 years with Alport syndrome and proteinuria, regardless of hypertension.
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