English abstract
Background: Hypertension is a worldwide problem as 26% of all adults of the world have Hypertension. It is expected that in 2025 the percentage will rise to 29% with estimation of 1.56 billion affected adults. In Oman, a community based survey conducted in 2000 estimated the prevalence of hypertension to be 33%. Many studies have shown the efficacy of (irbesartan/HCTZ, Coaprovel) combination therapy over (valsartan/HCTZ, Codiovan) combination. As many patients at Sultan Qaboos University hospital (SQUH) are on either drugs, this study evaluates hypertensive patients receiving irbesartan/HCTZ and valsartan/HCTZ over six months period,
Aim: To follow-up the pharmacological management of hypertensive patients receiving irbesartan (plus hydrochlorothiazide) or valsartan (plus hydrochlorothiazide) over six months period at SQUH, Oman.
Design and method: A retrospective observational study of the adult patients aged 18 years and above who were attending the SQUH clinics of the Outpatient Department (OPD) during July, August, and September 2010 and were documented in the patients' medical records to have the diagnosis of hypertension.
Results: 163 patients were receiving valsartan plus hydrochlorothiazide, and 69 patients received irbesartan plus hydrochlorothiazide. At baseline, systolic blood pressure (SBP) was significantly higher in the irbesartan group compared to the valsartan cohort (153 versus 144 mmHg; p=0.004). However, no significant differences were noted in baseline diastolic blood pressure (DBP) (81 versus 77 mmHg; p=0.056). Compared to the valsartan cohort, the irbesartan group was associated with bigger reductions in both SBP (-9 versus -2 mmHg; p=0.021) and DBP (-5 versus 0 mmHg; p=0.022). With regards to post-index values, no significant differences were noted in DBP (76 versus 77 mmHg; p=0.574) and SBP (144 versus 142 mmHg; p=0.618), respectively. For overall blood pressure control, the proportion that attained control was significantly higher in the valsartan group compared to the irbesartan cohort (43% versus 29%; p=0.046). However, this difference did not reach significance when adjusted for baseline SBP and DBP values (p=0.228). Furthermore, when stratified by diabetes mellitus, blood pressure reductions were noted more in diabetics than non-diabetic patients.
Conclusions: As compared to the valsartan/HCTZ cohort, the irbesartan/HCTZ group was associated with bigger reductions in both SBP (-9 versus -2 mmHg; p=0.021) and DBP (-5 versus 0 mmHg; p=0.022). However, no direct head-to-head comparison could be made because of the study design. There was no significant difference in the proportion that attained control as regards to overall blood pressure control between the two groups (p=0.228) after adjustment for baseline ŞBP and DBP values. Blood pressure reductions were noted more in diabetics than non-diabetic patients. These data suggest that irbesartan/HCTZ is an appropriate therapy for patients with hypertension and diabetes.
