Abstract
We studied the effects of changing from an angiotensin II type 1 receptor blocker (ARB) to combined losartan (50 mg) and hydrochlorothiazide (12.5 mg) on blood pressure, renal status, and metabolism in subjects with type 2 diabetes and uncontrolled hypertension, i.e., systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥80 mmHg. Subjects numbered 84 outpatients taking a usual dose of ARB were enrolled and followed up for 6 months in open observation. Blood pressure and HbA1c (JDS) were measured monthly. Blood pressure decreased significantly during these 6 months from an average of 151/82 mmHg at baseline to 136/73 mmHg. HbA1c increased significantly 0.2% in 1 to 5 months. Biomedical markers measured every three months showed a mild but significant increase in uric acid and decrease in HDL cholesterol and potassium. Urinary albumin creatinine ratio and estimated glomerular filtration rate decreased significantly with significant correlatim between their changes. In conclusion, changing from an ARB to losartan/hydrochlorothiazide markedly reduced blood pressure with renal protection and mildly adverse effects on metabolism in subjects with type 2 diabetes and uncontrolled hypertension.
