Valsartan combination therapy in the management of hypertension – patient perspectives and clinical utility

Figures & data

Figure 1 Responder rates (mean seated diastolic blood pressure [MSDBP] <90 mmHg or ≥ 10 mmHg reduction from baseline) and blood pressure control rates (mean seated systolic blood pressure [MSSBP]/MSDBP <140/90 mmHg) after 8 weeks of treatment in patients with mild to moderate hypertension.

*P < 0.05 vs placebo; ^†P < 0.05 vs respective HCTZ component; ^‡P < 0.05 vs respective valsartan component. Reprinted from Pool JL, Glazer R, Weinberger M, Alvarado R, Huang J, Graff A. Comparison of valsartan/hydrochlorothiazide combination therapy at doses up to 320/25 mg versus monotherapy: a double-blind, placebo-controlled study followed by long-term combination therapy in hypertensive adults. ClinTher. 2007;29(1):61–73.⁴⁴ Copyright © 2007, with permission from Excerpta Medica, Inc.

Abbreviations: BP, blood pressure; HCTZ, hydrochlorothiazide; VAL, valsartan.

Figure 2 Changes in ambulatory systolic and diastolic blood pressure from baseline over a 24-hour period after 10 weeks of treatment in a study of 482 patients with moderate hypertension. Reprinted with permission from Lacourcière Y, Wright Jr JT, Samuel R, Zappe D, Purkayastha D, Black HR. Effects of force-titrated valsartan/hydrochlorothiazide versus amlodipine/hydrochlorothiazide on ambulatory blood pressure in patients with stage 2 hypertension: the EVALUATE study. Blood Press Monit. 2009; 14(3):112–120.⁴⁷ Copyright © 2009 Lippincott Williams & Wilkins.

Abbreviations: AMLO, amlodipine; BP, blood pressure; HCTZ, hydrochlorothiazide; VAL, valsartan.

Figure 3 Changes in A) mean seated systolic blood pressure (MSSBP) and B) mean seated diastolic blood pressure (MSDBP) from baseline after 4 and 6 weeks of treatment in a study of 608 patients with severe hypertension.

*P < 0.0001 vs valsartan monotherapy. Reprinted with permission from Calhoun DA, Glazer RD, Pettyjohn FS, Coenen PD, Zhao Y, Grosso A. Efficacy and tolerability of combination therapy with valsartan/hydrochlorothiazide in the initial treatment of severe hypertension. Curr Med Res Opin. 2008;24(8):2303–2311.⁴⁹ Copyright © 2008 Informa Healthcare.

Abbreviations: HCTZ, hydrochlorothiazide; LOCF, last observation carried forward; VAL, valsartan.

Figure 4 Least-squares mean changes in mean seated systolic blood pressure (MSSBP) from baseline after 4 weeks of treatment across various patient subgroups with moderate hypertension. Elderly patients were ≥65 years of age.

*P < 0.05 vs amlodipine. Reprinted from Destro M, Luckow A, Samson M, Kandra A, Brunel P. Efficacy and safety of amlodipine/valsartan compared with amlodipine monotherapy in patients with stage 2 hypertension: a randomized, double-blind, multicenter study: the EX-EFFeCTS Study. J Am Soc Hypertens. 2008;2(4):294–302.⁶² Copyright © 2008 with permission from Elsevier.

Notes: Values in parentheses denote SEM.
Abbreviations: AMLO, amlodipine; BMI, body mass index; ISH, isolated systolic hypertension; SEM, standard error of the mean; VAL, valsartan.

Figure 5 Changes in mean seated systolic blood pressure (MSSBP) over time in black patients with moderate hypertension. Reprinted by permission from Macmillan Publishers Ltd: Flack JM, Calhoun DA, Satlin L, Barbier M, Hilkert R, Brunel P. Efficacy and safety of initial combination therapy with amlodipine/valsartan compared with amlodipine monotherapy in black patients with stage 2 hypertension: the EX-STAND study. J Hum Hypertens. 2009;23(7):479–489.⁶⁴ Copyright © 2009.

Abbreviations: AMLO, amlodipine; HCTZ, hydrochlorothiazide; SEM, standard error of the mean; VAL, valsartan.

Figure 6 Changes in mean seated systolic blood pressure (MSSBP) from baseline after 8 weeks of treatment in patients whose blood pressure was uncontrolled on previous antihypertensive monotherapy. Results are shown by previous antihypertensive monotherapy. Reprinted with permission from Allemann Y, Fraile B, Lambert M, Barbier M, Ferber P, Izzo JL Jr. Efficacy of the combination of amlodipine and valsartan in patients with hypertension uncontrolled with previous monotherapy: the Exforge in Failure after Single Therapy (EX-FAST) study. J Clin Hypertens (Greenwich). 2008;10(3):185–194.⁶⁵ Copyright © 2008 John Wiley and Sons, Inc.

Abbreviations: ACEI, angiotensin-converting enzyme inhibitor; AMLO, amlodipine; ARB, angiotensin receptor blocker; CCB, calcium channel blocker; VAL, valsartan.

Table 1 Angiotensin receptor blocker single-pill combinations

Combination	Doses available
Diuretic combinations
Candesartan cilexitil/HCTZ (Atacand-HCT^®)^a	16/12.5 mg; 32/12.5 mg; 32/25 mg
Eprosartan mesylate/HCTZ (Teveten HCT^®)^a	600/12.5 mg; 600/25 mg
Irbesartan/HCTZ (Avalide^®)	150/12.5 mg; 300/12.5 mg
Losartan/HCTZ (Hyzaar^®)	50/12.5 mg; 100/12.5 mg; 100/25 mg
Olmesartan medoxomil/HCTZ (Benicar HCT^®)^a	20/12.5 mg; 40/12.5 mg; 40/25 mg
Telmisartan/HCTZ (Micardis HCT^®)^a	40/12.5 mg; 80/12.5 mg; 80/25 mg
Valsartan/HCTZ (Diovan-HCT^®)	160/12.5 mg; 160/25 mg; 320/12.5 mg; 320/25 mg
Calcium channel blocker combinations
Amlodipine/valsartan (Exforge^®)	5/160 mg; 10/160 mg; 5/320 mg; 10/320 mg
Amlodipine/olmesartan (Azor^®)	5/20 mg; 10/40 mg

a The single-pill combination is not approved for first-line use.

Abbreviation: HCTZ, hydrochlorothiazide.

PoolJLGlazerRWeinbergerMAlvaradoRHuangJGraffAComparison of valsartan/hydrochlorothiazide combination therapy at doses up to 320/25 mg versus monotherapy: a double-blind, placebo-controlled study followed by long-term combination therapy in hypertensive adultsClin Ther2007291617317379047

 PubMed Web of Science ®Google Scholar

LacourcièreYWrightJTJrSamuelRZappeDPurkayasthaDBlackHREffects of force-titrated valsartan/hydrochlorothiazide versus amlodipine/hydrochlorothiazide on ambulatory blood pressure in patients with stage 2 hypertension: the EVALUATE studyBlood Press Monit200914311212019384192

 PubMed Web of Science ®Google Scholar

CalhounDAGlazerRDPettyjohnFSCoenenPDZhaoYGrossoAEfficacy and tolerability of combination therapy with valsartan/hydrochlorothiazide in the initial treatment of severe hypertensionCurr Med Res Opin20082482303231118593517

 PubMed Web of Science ®Google Scholar

DestroMLuckowASamsonMKandraABrunelPEfficacy and safety of amlodipine/valsartan compared with amlodipine monotherapy in patients with stage 2 hypertension: a randomized, double-blind, multicenter study: the EX-EFFeCTS StudyJ Am Soc Hypertens20082429430220409909

 PubMed Web of Science ®Google Scholar

FlackJMCalhounDASatlinLBarbierMHilkertRBrunelPEfficacy and safety of initial combination therapy with amlodipine/valsartan compared with amlodipine monotherapy in black patients with stage 2 hypertension: the EX-STAND studyJ Hum Hypertens200923747948919190658

 PubMed Web of Science ®Google Scholar

AllemannYFraileBLambertMBarbierMFerberPIzzoJLJrEfficacy of the combination of amlodipine and valsartan in patients with hypertension uncontrolled with previous monotherapy: the Exforge in Failure after Single Therapy (EX-FAST) studyJ Clin Hypertens (Greenwich)200810318519418326958

 PubMed Web of Science ®Google Scholar