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ALPINE
Antihypertensive treatment and Lipid Profile In a North of Sweden Efficacy evaluation
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Author(s) |
Lindholm LH, Persson M, Alaupovic P, Carlberg B, Svensson A, Samuelsson O
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Title(s) |
Metabolic outcome during 1 year in newly detected hypertensives: results of the Antihypertensive Treatment and Lipid Profile in a North of Sweden Efficacy Evaluation (ALPINE study)
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Reference(s) |
J Hypertens 2003;21:1563-74 |
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Disease |
Hypertension
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Purpose |
To compare the long-term effects of treatment with a low-dose diuretic (hydrochlorothiazide, HCTZ), alone or in combination with a beta-blocker (atenolol), with that of an angiotensin II type 1 receptor blocker (candesartan), alone or in combination with a calcium antagonist (felodipine), in newly diagnosed patients with primary hypertension
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Study design |
Randomised, double-blind, controlled, parallel-group
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Follow-up |
1 year
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Patients |
392 patients (196 candesartan, 196 HCTZ), mean age 55 years, with newly diagnosed primary hypertension (sitting BP 140-179/90-104 mm Hg)
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Treatment regimen |
Candesartan cilexetil, 16 mg, or HCTZ, 25 mg
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Concomitant therapy |
If sitting SBP or DBP was above the target pressure (< 130/ < 85 mm Hg, for patients aged < 65 years, or < 140/< 90 mm Hg, if aged > 65 years) at any visit during the treatment period, double-blind treatment with felodipine extended release, 2.5-5.0 mg, was added to candesartan, and atenolol, 50-100 mg, was added to HCTZ
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Results |
65% of patients in the candesartan group and 62% in the HCTZ group attained a BP < 140/< 90 mm Hg. Fasting serum insulin and plasma glucose levels increased in the HCTZ group compared to unaffected levels in the candesartan group. Diabetes mellitus was diagnosed in 4.1% of patients in the HCTZ group and in 0.5% in the candesartan group (p = 0.03). The ratio between LDL cholesterol and HDL cholesterol was reduced in the candesartan group and increased in the HCTZ group (p < 0.01). The effect on triglycerides was also significantly different, with a minor increase in the plasma levels with candesartan and a larger increase with HCTZ (p < 0.001). Serum potassium decreased in the HCTZ group and increased slightly in the candesartan group (0.27 vs +0.07 mmol/l; p < 0.001). Significantly less patients reported adverse events in the candesartan group
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Comments |
The results of a cost-effectiveness analysis have been published in J Hypertens 2006;24 Suppl 1:S65–72
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