Objective To assess the efficacy and safety Losartan for essential hypertension associated withhyperuricemia. Methods Included randomized controlled trials of Losartan versus Valsartan. Electronic searchconducted in CENTRAL, the Cochrane Library (until 2008, Issue 4), PubMed, EMBASE, Chinese Biomedicine database,Chinese Scientific Journals Full-text Database, and China Journal Full-text Database (until 2008, Issue 10). Two reviewers extracted data independently. RevMan 5.0 software developed by the Cochrane Collaboration was used for Metaanalysis.Results Only 7 trials with 1 136 eligible patients were included in the systematic review. Meta-analysis showedno significant difference in reductions of systolic blood pressure, diastolic blood pressure, and adverse events betweenLosartan and Valsartan groups. However, a significant difference of serum uric acid reduction was observed betweenLosartan and Valsartan group. Losartan play a significant role of decreased serum uric acid levels. Conclusions Based on this systematic review, Losartan is effective and well tolerated in reducing BP and serum uric acid levels. Further large randomized, double blind, placebo controlled trials are needed in long-term safety and efficacy and different subgroups of Losartan.
Objective To observe the effects of valsartan/ hydrochlorothiazide and valsartan on left ventricular thickness and the left ventricular diastolic function in patients with essential hypertension and left ventricular hypertrophy and impaired left ventricular diastolic function. Methods 56 patients of essential hypertension with left ventricular hypertrophy and impaired left ventricular diastolic function were randomized into two randomized double-blind groups, valsartan/hydrochlorothiazide (HCTZ) 80/12.5 mg o.d were gave to A group and valsartan 80 mg o.d were gave to B group. The dosage would be doubled in patients whose SDBP ≥ 12 kPa or SSBP ≥ 18.7 kPa after 4 weeks. Treatment lasted for 6 months. Result At the end of 6 months, valsartan/ hydrochlorothiazide and valsartan significantly reduced BP from baseline (Plt;0.01), there was significant difference in reducing BP between the two groups (Plt;0.05). Indexes of left ventricular diastolic function (IVST, LVPWT, LVMI) significantly decreased (Plt;0.01). LVEF increased significantly (Plt;0.01). There was significant difference in IVST, LVPWT, LVMI and LVEF between two groups (Plt;0.05). Conclusion Valsartan/ hydrochlorothiazide (HCTZ) can not only decrease blood pressure effectively, but also can significantly improve left ventricular hypertrophy and left ventricular diastolic function.
ObjectiveTo systematically review the efficacy of amlodipine versus valsartan in the treatment of diabetes mellitus combined with hypertension and renal impairment. MethodsAll relevant randomized controlled trials (RCTs) were retrieved in WanFang Data, CNKI, VIP, CBM, The Cochrane Library (Issue 10, 2013), PubMed, EMbase and Ovid up to October 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2. ResultsNine RCTs were finally included involving 794 cases. The results of meta-analysis showed that amlodipine was better than valsartan in improving 24-hour proteinuria (basic level < 1 000 mg:WMD=-10.24, 95%CI-18.52 to-1.95, P=0.02; basic level > 1 000 mg:WMD=-575.69, 95%CI-781.02 to-370.36, P < 0.000 01). However, there was no significant difference between two groups in lowing urine albumin excretion rates (UAER), serum creatinine (Scr), systolic blood pressure (SBP), diastolic blood pressure (DBP), and incidences of adverse events (UAER:WMD=-11.29, 95%CI-27.93 to 5.36, P=0.18; Scr:WMD=1.05, 95%CI-3.89 to 5.99, P=0.68; SBP:WMD=0.52, 95%CI-0.83 to 1.87, P=0.45; DBP:WMD=-0.40, 95%CI-1.41 to 0.62, P=0.44; ADR:WMD=1.00, 95%CI 0.3 to 3.34, P=1.00). ConclusionCurrent evidence shows that, compared with valsartan, amlodipine has the same efficacy in treatment of diabetes mellitus combined with hypertension and renal impairment, and it is even better in improving 24-hour proteinuria.