LAUSR

BACKGROUND Antihypertensive therapy using renin-angiotensin system blockers and calcium channel blockers to target blood pressure variability (BPV) has not yet been established. We aimed to compare the ability of losartan and amlodipine to lower BPV and systolic BP (SBP) in essential hypertensive patients. METHODS Patients were randomly assigned either losartan 50 mg or amlodipine 5 mg. Medications were up-titrated and hydrochlorothiazide was added according to protocol for 6 months. The primary endpoint was the office visit-to-visit standard deviation (SD) of SBP. The secondary endpoints included average real variability (ARV), office SBP and home SBP. RESULTS The losartan group (n=71) and amlodipine group (n=73) finished the scheduled visits between April 2013 and May 2017. The office visit-to-visit SD of SBP was comparable between the losartan and amlodipine groups (11.0±4.2 vs. 10.5±3.8, p=0.468). The office visit-to-visit ARV of SBP was significantly elevated in the losartan group (10.6±4.3 vs. 9.1±3.4, p=0.02). The absolute SBP decrement from baseline to 6 months was similar between groups, although the office mean SBP at 6 months was higher in the losartan group (132.3±12.9 mmHg vs. 127.5±9.0 mmHg, p=0.011). In home BP analysis, evening day-to-day BPV indexes (SD and ARV) were significantly higher in the losartan group at 6 months. CONCLUSION The lowering effect of the office visit-to-visit SD of SBP was similar between losartan and amlodipine. However, the losartan group showed a higher office visit-to-visit ARV of SBP and evening day-to-day home BPV indexes. Therefore, amlodipine may be better to lower BPV in essential hypertensive patients.