What is the most common condition?

From the Guidelines

Hypertension is the most common chronic condition seen by primary care physicians, affecting approximately 78 million people in the United States. This condition is a significant risk factor for various severe health issues, including coronary artery disease, congestive heart failure, stroke, end-stage renal disease, and peripheral vascular disease 1. The relationship between blood pressure and cardiovascular events, as well as renal disease, is directly linear, starting from a systolic blood pressure as low as 110 mm Hg. Key points to consider include:

• The direct linear relationship between blood pressure and the risk of cardiovascular events and renal disease 1
• The benefits of reducing systolic blood pressure, with decreases as small as 10 mm Hg shown to reduce the risk of cardiovascular or stroke death 1
• The challenges in establishing optimal blood pressure treatment targets, despite the clear benefits of blood pressure management 1 Given the significant impact of hypertension on morbidity, mortality, and quality of life, managing this condition is crucial in clinical practice, focusing on reducing blood pressure to minimize the risk of associated diseases 1.

From the FDA Drug Label

In 4 clinical trials involving over 1000 patients on various doses (10 to 150 mg) of losartan potassium and over 300 patients given placebo, the adverse events that occurred in ≥2% of patients treated with losartan and more commonly than placebo were: dizziness (3% vs. 2%), upper respiratory infection (8% vs. 7%), nasal congestion (2% vs. 1%), and back pain (2% vs 1%). The adverse events, regardless of drug relationship, reported with an incidence of ≥4% of patients treated with losartan and occurring with ≥2% difference in the losartan group vs placebo on a background of conventional antihypertensive therapy, were asthenia/fatigue, chest pain, hypotension, orthostatic hypotension, diarrhea, anemia, hyperkalemia, hypoglycemia, back pain, muscular weakness, and urinary tract infection.

The most common adverse events associated with losartan are:

• Upper respiratory infection (8% vs. 7% with placebo)
• Dizziness (3% vs. 2% with placebo)
• Back pain (2% vs. 1% with placebo)
• Nasal congestion (2% vs. 1% with placebo) These events were reported in clinical trials involving over 1000 patients on various doses of losartan potassium 2.

From the Research

Most Common Combination Therapies for Hypertension

• The combination of amlodipine plus valsartan is a potentially useful therapeutic option for patients with stage 2 hypertension, as it has been shown to be well tolerated and efficacious in achieving blood pressure reduction 3.
• Another common combination is losartan/hydrochlorothiazide, which has been compared to candesartan/amlodipine in terms of efficacy and safety, with both combinations being effective in reducing blood pressure 4.
• A study comparing the efficacy and safety of combined therapy with losartan, amlodipine, and hydrochlorothiazide found that the combination of losartan and amlodipine was more effective in reducing blood pressure than the maximal doses of losartan or amlodipine with hydrochlorothiazide 5.
• A multicenter study investigated the efficacy of different combinations of antihypertensive therapy on blood pressure, arterial stiffness, and peripheral resistance, and found that lisinopril, losartan, or valsartan alone or in combination with hydrochlorothiazide, with or without amlodipine, were equally effective and well tolerated for reducing blood pressure and improving arterial stiffness 6.
• A double-blind, randomized crossover study found that the combination of amlodipine and lisinopril had a marked additional effect on blood pressure compared to either drug alone, and that the response to amlodipine tended to be greater in patients with higher initial blood pressure 7.

Predictors of Response to Combination Therapy

• Baseline plasma renin activity has been found to be a predictor of response to lisinopril, with higher renin activity associated with a greater fall in blood pressure 7.
• The severity of hypertension has also been found to be a predictor of response to amlodipine, with patients with higher initial blood pressure tend to respond better to amlodipine 7.
• Race has also been found to be a factor, with Black patients tend to respond less well to lisinopril monotherapy compared to Caucasian patients, although they respond similarly to the combination of amlodipine and lisinopril 7.