Adverse Events Profiles during Initiation of Treatment with Amlodipine or Hydrochlorothiazide in Type 2 Diabetic Nigerians with Essential Hypertension
American Journal of Internal Medicine
Volume 2, Issue 6, November 2014, Pages: 131-137
Received: Nov. 30, 2014;
Accepted: Dec. 14, 2014;
Published: Dec. 19, 2014
Views 2741 Downloads 138
G. B. S. Iyalomhe, Department of Pharmacology and Therapeutics, College of Medicine, Ambrose Alli University, Ekpoma, Nigeria
E. K. I. Omogbai, Department of Pharmacology and Toxicology, Faculty of Pharmacy, University of Benin, Benin City, Nigeria
A. O. Isah, Department of Internal Medicine, College of Medical Sciences, University of Benin, Benin City, Nigeria
S. I. Iyalomhe, Department of Public Health and Primary Health Care, Central Hospital, Auchi, Nigeria
Background: Although, amlodipine (AML) and hydrochlorothiazide (HCZ) are recommended to initiate therapy in hypertensive patients, it has not been properly evaluated whether AML or HCZ would demonstrate a better adverse events profile. Objective: To determine whether AML or HCZ would be preferable to initiate antihypertensive treatment in type 2 diabetic Nigerians by comparing the adverse events profiles of the 2 drugs. Methods: Forty male (M) and female (F) newly diagnosed hypertensive subjects with controlled type 2 diabetic mellitus (T2DM) aged 43-68 years were randomized to AML and HCZ treatment groups of 20 patients each (10 Ms, 10 Fs), and they were treated respectively, with AML 10mg and HCZ 25mg, both drugs being given once daily for 48 weeks. Body mass index (BMI) was calculated for each subject. Blood pressure (BP), heart rate (HR), 24h urine volume were assessed at baseline and at the end of weeks 1, 3, 6, 12, 24, 36, and 48. Adverse events profiles were also recorded from week 1 through 48. Results: The drugs significantly reduced BP, though the effect of AML was significantly greater compared to that of HCZ (P<0.01). Diuresis was significant in HCZ group (P<0.01). There were 48 adverse events (48.5%) in the AML group including weight loss and mild tachycardia. No patient had peripheral pedal edema. Fifty one events (51.5%) occurred in HCZ group, weight loss, mild tachycardia, polyuria and myalgia/cramps being the commonest as well as impotence and visual disturbance. Conclusion: Though the two drugs appeared to be well tolerated, AML demonstrated a better BP-lowering effect and adverse events profile. Drugs that ensure adequate BP control and have the lowest possible risk for adverse events like AML, should be preferably used in diabetic Nigerian patients with essential hypertension.
G. B. S. Iyalomhe,
E. K. I. Omogbai,
A. O. Isah,
S. I. Iyalomhe,
Adverse Events Profiles during Initiation of Treatment with Amlodipine or Hydrochlorothiazide in Type 2 Diabetic Nigerians with Essential Hypertension, American Journal of Internal Medicine.
Vol. 2, No. 6,
2014, pp. 131-137.
V. Mohan, Y.K. Seedat, and R. Pradeepa, “The rising burden of diabetes and hypertension in Southeast Asia and African regions: need for effective strategies for prevention and control in primary health care settings”, Int. J. Hypertens., vol. 2013, Article ID 409083, 14 pages. http://dx.doi.org/10.115/2013/409083.
G.B.S. Iyalomhe, E.K.I. Omogbai, A.O. Isah, S.I. Iyalomhe, O. Okhiai, F.L. Dada, and O.O.B. Iyalomhe, “Comparison of the long-term efficacy and some metabolic effects of initiating therapy with amlodipine or hydrochlorothiazide in hypertensive type 2 diabetic Nigerians”. Int. J. Health Sci. Res. vol.4, No.7, pp. 149-161, 2014.
O.O. Ogunleye, S.O. Ogundele, J.O. Akinyemi, and A.O. Ogbera, “Clustering of hypertension, diabetes mellitus and dyslipidemia in a Nigerian population: a cross sectional study”. Afr. J. Med. Med. Sci., vol.41, pp.191-195, 2012.
B.C. Unadike, A. Eregie, and A.E. Ohwovoriole, “Prevalence of hypertension amongst persons with diabetes mellitus in Benin City, Nigeria”. Nig. J. Clin. Pract., vol.14, pp.300-302, 2011.
G.B.S. Iyalomhe, E.K.I. Omogbai, and O.O.B. Iyalomhe, “Long-term electrolyte effects during initiation of antihypertensive therapy with amlodipine or hydrochlorothiazide in diabetic Nigerians”, Am. J. Med. Sci. Med., vol.1, No3, pp.1-7, 2013.
G.B.S. Iyalomhe, “Compliance to antihypertensive therapy”, Nig. Clin. Rev. J., vol.63, pp.12-16, 2007.
D.A. Oke, and E.O. Bandele, “Misconceptions of hypertension”, J. Nat. Med. Assoc., vol.96, pp.1221-1224, 2004.
G.B.S. Iyalomhe, and S.I. Iyalomhe, “Hypertension-related knowledge, attitudes and life-style practices among hypertensive patients in a sub-urban Nigerian community”, J. Public Health Epidemiol., vol.2, No.4, pp.71-77, July 2010.
B.B. Hoffman, “Therapy of hypertension”, in Goodman and Gilman’s The pharmacological Basis of Therapeutics, 11th ed., J. G. Hardman and L.E. Limbird, Eds. New York: McGraw Hill, 2006, pp.845-868.
N.L. Benowitz, “Antihypertensive agents”, in Basic and Clinical Pharmacology 11th ed, B.G. Katzung Ed., Boston: McGraw Hill Lange, 2009, pp: 167–189.
G.B.S. Iyalomhe, E.K.I. Omogbai, A.O. Isah, O.O.B. Iyalomhe, F.L. Dada, and S.I. Iyalomhe, “Effects of initiating therapy with amlodipine or hydrochlorothiazide on creatinine clearance in hypertensive Nigerians with type 2 diabetes mellitus”, Br. Biotech. J. vol.3, No.1, pp.79-89, 2013.
G.B.S. Iyalomhe, E.K.I. Omogbai, A.O. Isah, O.O.B. Iyalomhe, F.L. Dada, and S.I. Iyalomhe, “Efficacy of initiating therapy with amlodipine and hydrochlorothiazide or their combination in hypertensive Nigerians”. Clin. Exper. Hypertens. Early online 1-8 2013; DOI: 10.3109/10641963.776570.
G.B.S. Iyalomhe, E.K.I. Omogbai, and R.I. Ozolua “Antihypertensive and biochemical effects of hydrochlorothiazide and furosemide in hypertensive Nigerians”, J. Med. Sci., vol.7, No.6, pp.977-983, Aug 2007.
O.O. Akinkugbe, “Current epidemiology of hypertension in Nigeria”, Arch. Ibadan Med., vol.1, pp.3–5, 2003.
T.G. Pickering, J.E. Hall, L.J. Appel, B.E. Falkner, J. Graves, M.N Hill, D.W. Jones, T. Kurtz, S.G. Sheps, and E.J. Rocella, “Recommendations for blood pressure measurement in humans and experimental animals part1. Blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research”, Circulation., vol.ΙΙΙ, pp.697-716, 2005.
T. Tejada, A. Fornomi, O. Lenz, and B.J. Materson, “Combination therapy with renin-angiotensin system blockers: will amlodipine replace hydrochlorothiazide?”, Curr. Hypertens. Rep., vol.9, pp.284–290, 2007.
ALLHAT Collaborative Research Group, “Outcomes in hypertensive black and non-black patients treated with chlorthalidone, amlodipine and lisinopril”. JAMA, vol.293, No.13, pp.1595-1598, 2005.
D.P. Mikhailidis, M.A. Khan, H.J. Milioris, and R.H. Morgan, “The treatment of hypertension in patients with erectile dysfunction”, Curr. Med. Res. Opin., vol.16, No.5l, pp.531-536, 2000.
F.H. Messerli, S. Bangalore, and S. Julius, “Risk / benefit assessment of ß-blockers and diuretics precludes their use for first-line therapy in hypertension”, Circulation, vol.117, pp.2706-2715, 2008.
R.H. Grim, G.A. Grandits, R.J. Prineas, R.H. McDonald, C.E. Lewis, and J.M. Flack for the TOMHS Research Group, “Long-term effects on sexual function of five antihypertensive drugs and nutrition hygienic treatment in hypertensive men and women. Treatment of Mild Hypertension Study (TOMHS)”, Hypertens., vol.29, pp.8-14, 1997.
E. Grossman, F.H. Messerli, and V. Goldbourt, “Does diuretic therapy increase the risk of renal cell carcinoma?”, Am. J. Cardiol., vol.83, pp.1090-1093, 1997.
S. Reungjul, H. Hu, W. Mu, CA. Roncal, B.P. Croker, J.M. Pater, T. Nakagawa, T. Srinivas, K. Byer, J. Simoni, D. Wesson, V. Sitprija, and R.J. Johnson, “Thiazide-induced subtle renal injury not observed in states of equivalent hypokalaemia”, Kidney Int., vol.72, pp.1483-1492, 2007.
B.H. Rovin, and L.A. Hebert, “Thiazide diuretic monotherapy for hypertension: diuretic’s dark side just got darker”, Kidney Int. vol.72, pp.1423-1426, 2007.
D.H. Ellison, and J. Loffing, “Thiazide effects and adverse effects: insight from molecular genetics”, Hypertens., vol.54, pp.196-204, 2009.
Royal College of Physicians, National Collaborating Centre for Chronic Conditions. “Hypertension: management of hypertension in adults in primary care, partial update”, London, UK, 2006.