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A comparison of the efficacy and safety of irbesartan/HCTZ combination therapy with irbesartan and HCTZ monotherapy in the treatment of moderate hypertension


This prospective, double-blind, parallel-group study randomized patients with moderate hypertension (seated systolic blood pressure (SeSBP) 160–179 mm Hg when seated diastolic blood pressure (SeDBP) <110 mm Hg; or SeDBP 100–109 mm Hg when SeSBP <180 mm Hg) 3:1:1 to treatment with irbesartan 300 mg/hydrochlorothiazide (HCTZ) 25 mg combination therapy (n=328), irbesartan 300 mg monotherapy (n=106) or HCTZ monotherapy 25 mg (n=104). Treatment was initiated at half dose, with forced titration to full dose after two weeks followed by ten further weeks' treatment. The primary efficacy variable was the mean reduction in SeSBP from baseline to week 8. Baseline characteristics were similar between groups, with mean baseline blood pressure approximately 162/98 mm Hg; the mean age was 55 years. At week 8 there was a reduction in SeSBP of 27.1 mm Hg with irbesartan/HCTZ, compared with 22.1 mm Hg with irbesartan monotherapy (P=0.0016) and 15.7 mm Hg with HCTZ (P<0.0001). Both the rate of decline and the total degree of decline achieved were greatest with irbesartan/HCTZ and least with HCTZ. A significantly greater percentage of patients reached a treatment goal of SeSBP <140 mm Hg and SeDBP <90 mm Hg by week 8 with irbesartan/HCTZ (53.4%), compared with irbesartan (40.6%; P=0.0254) and HCTZ (20.2%; P<0.0001) alone. Treatment was well tolerated in all three-treatment groups with a slight increase in adverse events in the combination therapy group. In conclusion, irbesartan/HCTZ (300/25 mg) is well tolerated and achieves rapid and sustained reductions in both systolic blood pressure and diastolic blood pressure in patients with moderate hypertension.

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This study was sponsored by Bristol-Myers Squibb and Sanofi-aventis.

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Correspondence to J M Neutel.

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JMN: grant and research support from Boehringer-Ingelheim, Bristol-Myers Squibb, GlaxoSmithKline, Pfizer, Alteon, AtheroGenics and Novartis; Speakers’ Bureau for Novartis, Bristol-Myers Squibb, Sanofi-aventis, Sankyo, Boehringer-Ingelheim, Biovail, Reliant and Pfizer; consultant for Bristol-Myers Squibb, Sanofi-aventis, Novartis, Biovail, Sankyo, Mylan Bertek and Boehringer-Ingelheim. SSF: Speakers’ Bureau for Boehringer Ingelheim, Bristol-Myers Squibb and Merck; consultant for AtCor Medical, Bristol-Myers Squibb, Merck and Pfizer.

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Neutel, J., Franklin, S., Lapuerta, P. et al. A comparison of the efficacy and safety of irbesartan/HCTZ combination therapy with irbesartan and HCTZ monotherapy in the treatment of moderate hypertension. J Hum Hypertens 22, 266–274 (2008).

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  • irbesartan
  • irbesartan/HCTZ
  • angiotensin receptor blocker
  • moderate hypertension
  • combination therapy

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