Effects of amlodipine plus
telmisartan or amlodipine plus
amiloride regimen on blood
pressure control in hypertensive
patients: preliminary report of
Chinese Hypertension Intervention
Efficacy (CHIEF) trial
Wang W, Ma LY, Liu MB et al. Zhonghua Xin Xue Guan Bing Za Zhi. 2009;37:701-707.
Objectives of the study
To evaluate blood pressure reduction with
anamlodipine-based regimen
(amlodipine/telmisartan and amlodipine/coamiloride) and its impact on cardiovascular
morbidity and mortality.
Methods
• 13542 hypertensive patients from 180 centers in China
were followed for 4 years.
• All patients between 50 and 79 years of age with
essential hypertension (I-II grade)
• At least one cardiovascular risk factor
• Patients randomly assigned to group A (low-dose
amlodipine + co-amiloride) or group T (low-dose
amlodipine + telmisartan)
• Primary end points : nonfatal stroke/myocardial
infarction and cardiovascular death
Results
• Baseline characteristics of patients were
homogeneous between the two groups:
-
Mean age 61.5±7.7 years old
19% history of cerebrovascular disease
12% coronary disease
18% diabetes
42% dyslipidemia
Mean initial blood pressure was 157/93 mm Hg
Blood pressure reduction
Group A (amlodipine + co-amiloride)
Group T (amlodipine + telmisartan)
180
160
140
120
100
80
60
40
20
0
157
131.08
93
79.16
Baseline
4 years
End points
Group T
(temilsartan +
amlodipine)
Group A (Coamiloride +
amlodipine)
Hazard
ratios
Primary end point
186 (2.7)
163 (2.4)
1.14
Total stroke
141 (2.1)
127 (1.7)
1.20
Nonfatal stroke
130 (1.9)
108 (1.6)
1.20
Fatal stroke
14 (0.2)
12 (0.2)
1.20
Total MI
26 (0.4)
30 (0.4)
0.86
Nonfatal MI
18 (0.3)
24 (0.4)
0.75
Fatal MI
9 (0.1)
6 (0.1)
1.50
Cardiovascular death
44 (0.7)
34 (0.5)
1.33
Non-ardiovascular
death
36 (0.5)
63 0.9)
0.58
Total death
80 (1.2)
97 (1.4)
0.84
95% CI
0
0.5
Group T (telmisartan + amlodipine) better
1.0
1.5
2.0
Group A (co-amiloride + amlodipine)
Conclusion
Amlodipine + ARB combination is not better than
amlodipine + diuretic combination in reducing
cardiovascular events in patients with hypertension