Essential Hypertension
Conditions
Keywords
Essential hypertension, blood pressure, edema, valsartan, amlodipine, combination treatment
Brief summary
This study was designed to compare the efficacy, tolerability, and safety of the combination valsartan/amlodipine 160/5 mg versus amlodipine 10 mg in patients with essential hypertension not adequately controlled (defined as mean sitting systolic blood pressure \[msSBP\] ≥ 130 mmHg and ≤ 160 mmHg) on amlodipine 5 mg alone. The study evaluated both the efficacy and tolerability of the treatments by providing data that assessed blood pressure and the proportion of patients developing peripheral edema.
Interventions
Sponsors
Novartis Pharmaceuticals
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
55 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Male or female outpatients ≥ 55 years of age * Patients with essential hypertension measured using a validated automated oscillometric device at Visit 1 * Non-treated patients must have a MSSBP ≥ 140 mmHg and ≤ 160 mmHg * Patients pre-treated on monotherapy prior to Visit 1 must have MSSBP ≤ 160 mmHg * To be eligible for randomization at Visit 2 (Day 1) all patients must have a MSSBP ≥ 130 mmHg and ≤ 160 mmHg * No peripheral edema at Visit 2 (randomization) * Written informed consent to participate in this study prior to any study procedures
Exclusion criteria
* Women of child-bearing potential, defined as all women physiologically capable of becoming pregnant * Known or suspected contraindications, including history of allergy or hypersensitivity to angiotensin receptor blockers, calcium channel blockers, or to drugs with similar chemical structures * Patients taking more than 1 antihypertensive medication at Visit 1 * Administration of any agent indicated for the treatment of hypertension after Visit 1 with the exception of pre-treated patients that require tapering down of anti-hypertensive treatments. For patients with previous antihypertensive medication that require a gradual downward titration, the tapering down should be done according to manufacturers instructions and last dose should be taken by week -2 prior to randomization * msSBP \> 180 mmHg or msDBP \> 110 mmHg at any time between Visit 1 and Visit 2 * Evidence of a secondary form of hypertension, including but not limited to any of the following: Coarctation of the aorta, hyperaldosteronism, unilateral or bilateral renal artery stenosis, Cushing's disease, polycystic kidney disease, or pheochromocytoma * History of hypertensive encephalopathy, cerebrovascular accident, transient ischemic attack, myocardial infarction, percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG) 12 months prior to Visit 1 * History of heart failure Grade II - IV according to the NYHA classification * Second or third degree heart block with or without a pacemaker * Concomitant potentially life threatening arrhythmia or symptomatic arrhythmia * Concomitant unstable angina pectoris * Clinically significant valvular heart disease * Patients with Type 1 diabetes mellitus * Patients with Type 2 diabetes mellitus who are not well controlled based on the investigator's judgment. It is recommended that Type 2 diabetic patients are adequately controlled and, if treated with medication, be on a stable dose of oral anti-diabetic medication for at least 4 weeks prior to Visit 1 * Evidence of hepatic disease as determined by one of the following: AST or ALT values \> 2x UNL at study entry, a history of hepatic encephalopathy, history of esophageal varices, or history of portocaval shunt * Evidence of renal impairment as determined by one of the following: serum creatinine \> 1.5 x UNL at visit 1, history of dialysis, or history of nephrotic syndrome * Serum potassium values \> 5.5 mmol/L at study entry * Any surgical or medical condition which might significantly alter the absorption, distribution, metabolism or excretion of any drug * Any surgical or medical condition which, at the discretion of the investigator or Novartis medical monitor, places the patient at higher risk from his/her participation in the study, or is likely to prevent the patient from complying with the requirements of the study or completing the study period * Volume depletion based on the investigator's clinical judgment using vital signs, skin turgor, moistness of mucous membranes, and laboratory values * Any severe, life-threatening disease within the past five years * History of drug or alcohol abuse within the last 2 years * Use of other investigational drugs at the time of enrollment, or within 30 days or 5 half-lives of enrollment, whichever is longer * Inability to communicate and comply with all study requirements including the unwillingness or inability to provide informed consent * Persons directly involved in the execution of this protocol
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Mean Sitting Systolic Blood Pressure (msSBP) From Baseline to Week 8 | Baseline to Week 8 | Blood pressure (BP) was measured at trough (24±3 hours post-dose). The arm in which the highest sitting diastolic BP was found at study entry was used for all subsequent readings. If there was \< 0. 5 mmHg difference in BP between the 2 arms, the non-dominant arm was used. At each visit, after the patient was in a sitting position with the back supported and both feet placed on the floor for 5 minutes, systolic and diastolic BP were measured 3 times with an automated BP monitor and appropriate size cuff. Means of the 3 measurements were calculated. A negative change indicates lowered BP. |
| Percentage of Patients With Peripheral Edema From Baseline to Week 8 | Baseline to Week 8 | Only occurrences of peripheral edema quantified as a reported adverse event coded as peripheral edema were included in the analysis. If a patient experienced more than one occurrence of peripheral edema between Day 1 and Week 8, it was only counted once in the analysis. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Mean Sitting Diastolic Blood Pressure (msDBP) From Baseline to Week 8 | Baseline to Week 8 | Blood pressure (BP) was measured at trough (24±3 hours post-dose). The arm in which the highest sitting diastolic BP was found at study entry was used for all subsequent readings. If there was \< 0. 5 mmHg difference in BP between the 2 arms, the non-dominant arm was used. At each visit, after the patient was in a sitting position with the back supported and both feet placed on the floor for 5 minutes, systolic and diastolic BP were measured 3 times with an automated BP monitor and appropriate size cuff. Means of the 3 measurements were calculated. A negative change indicates lowered BP. |
| Change in Mean Sitting Systolic and Diastolic Blood Pressure (msSBP, msDBP) From Baseline to Weeks 4, 8, and 12 | Baseline to Weeks 4, 8, and 12 | Blood pressure (BP) was measured at trough (24±3 hours post-dose). The arm in which the highest sitting diastolic BP was found at study entry was used for all subsequent readings. If there was \< 0. 5 mmHg difference in BP between the 2 arms, the non-dominant arm was used. At each visit, after the patient was in a sitting position with the back supported and both feet placed on the floor for 5 minutes, systolic and diastolic BP were measured 3 times with an automated BP monitor and appropriate size cuff. Means of the 3 measurements were calculated. A negative change indicates lowered BP. |
| Percentage of Patients Achieving a Systolic Response at Weeks 4, 8, and 12 | Baseline to Weeks 4, 8, and 12 | Systolic response was defined as msSBP \< 130 mmHg or at least a 20 mmHg reduction from baseline in msSBP at Weeks 4, 8, and 12. Blood pressure (BP) was measured at trough (24±3 hours post-dose). The arm in which the highest sitting diastolic BP was found at study entry was used for all subsequent readings. At each visit, after the patient was in a sitting position with the back supported and both feet placed on the floor for 5 minutes, systolic and diastolic BP were measured 3 times with an automated BP monitor and appropriate size cuff. Means of the 3 measurements were calculated. |
Countries
Argentina, Chile, Ecuador, Finland, France, Germany, Italy, Norway, Spain, Sweden, Switzerland, Turkey (Türkiye)
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Valsartan/Amlodipine 160/5 mg Twelve (12) weeks treatment with the combination of valsartan/amlodipine 160/5 mg. Together with the active medication, patients received a placebo that matched amlodipine 5 mg. The three capsules were taken by mouth with water once daily in the morning, regardless of meals. Patients were instructed not to take their study medication the morning of their study visits. Instead, they brought the study medication with them to the site and took it there as instructed by the investigator. | 592 |
| Amlodipine 10 mg Eight (8) weeks of treatment with amlodipine 10 mg (two 5 mg capsules). Together with the active medication, the patients received a placebo that matched valsartan 160 mg. At Week 8, patients were switched and treated with the combination of valsartan/amlodipine 160/5 mg and a placebo that matched amlodipine 5 mg for an additional 4 weeks until the end of the study. The three capsules were taken by mouth with water once daily in the morning, regardless of meals. Patients were instructed not to take their study medication the morning of their study visits. Instead, they brought the study medication with them to the site and took it there as instructed by the investigator. | 591 |
| Total | 1,183 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Administrative problems | 2 | 1 |
| Overall Study | Adverse Event | 15 | 84 |
| Overall Study | Condition no longer requires study drug | 1 | 1 |
| Overall Study | Lack of Efficacy | 2 | 1 |
| Overall Study | Lost to Follow-up | 2 | 3 |
| Overall Study | Protocol Violation | 3 | 3 |
| Overall Study | Withdrawal by Subject | 10 | 22 |
Baseline characteristics
| Characteristic | Valsartan/Amlodipine 160/5 mg | Amlodipine 10 mg | Total |
|---|---|---|---|
| Age, Continuous Overall study | 65.6 Age (years) STANDARD_DEVIATION 7.56 | 65.4 Age (years) STANDARD_DEVIATION 7.16 | 65.5 Age (years) STANDARD_DEVIATION 7.36 |
| Sex: Female, Male Female | 285 Participants | 284 Participants | 569 Participants |
| Sex: Female, Male Male | 307 Participants | 307 Participants | 614 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 61 / 592 | 201 / 591 |
| serious Total, serious adverse events | 11 / 592 | 8 / 591 |
Outcome results
Primary
Change in Mean Sitting Systolic Blood Pressure (msSBP) From Baseline to Week 8
Blood pressure (BP) was measured at trough (24±3 hours post-dose). The arm in which the highest sitting diastolic BP was found at study entry was used for all subsequent readings. If there was \< 0. 5 mmHg difference in BP between the 2 arms, the non-dominant arm was used. At each visit, after the patient was in a sitting position with the back supported and both feet placed on the floor for 5 minutes, systolic and diastolic BP were measured 3 times with an automated BP monitor and appropriate size cuff. Means of the 3 measurements were calculated. A negative change indicates lowered BP.
Time frame: Baseline to Week 8
Population: Intent-to-treat (ITT) population: All randomized patients who had a baseline and at least one post-baseline efficacy assessment. For patients who discontinued prior to Week 8, the last post-baseline msSBP measurement collected was used for the analysis (last observation carried forward \[LOCF\]).
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Valsartan/Amlodipine 160/5 mg | Change in Mean Sitting Systolic Blood Pressure (msSBP) From Baseline to Week 8 | -8.01 mmHg | Standard Error 0.5944 |
| Amlodipine 10 mg | Change in Mean Sitting Systolic Blood Pressure (msSBP) From Baseline to Week 8 | -6.30 mmHg | Standard Error 0.6088 |
95% CI: [-3, -0.44]ANCOVA
Primary
Percentage of Patients With Peripheral Edema From Baseline to Week 8
Only occurrences of peripheral edema quantified as a reported adverse event coded as peripheral edema were included in the analysis. If a patient experienced more than one occurrence of peripheral edema between Day 1 and Week 8, it was only counted once in the analysis.
Time frame: Baseline to Week 8
Population: Safety population: All randomized patients.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Valsartan/Amlodipine 160/5 mg | Percentage of Patients With Peripheral Edema From Baseline to Week 8 | 6.6 Percentage of patients |
| Amlodipine 10 mg | Percentage of Patients With Peripheral Edema From Baseline to Week 8 | 31.1 Percentage of patients |
Secondary
Change in Mean Sitting Diastolic Blood Pressure (msDBP) From Baseline to Week 8
Blood pressure (BP) was measured at trough (24±3 hours post-dose). The arm in which the highest sitting diastolic BP was found at study entry was used for all subsequent readings. If there was \< 0. 5 mmHg difference in BP between the 2 arms, the non-dominant arm was used. At each visit, after the patient was in a sitting position with the back supported and both feet placed on the floor for 5 minutes, systolic and diastolic BP were measured 3 times with an automated BP monitor and appropriate size cuff. Means of the 3 measurements were calculated. A negative change indicates lowered BP.
Time frame: Baseline to Week 8
Population: Intent-to-treat (ITT) population: All randomized patients who had a baseline and at least one post-baseline efficacy assessment. For patients who discontinued prior to Week 8, the last post-baseline msSBP measurement collected was used for the analysis (last observation carried forward \[LOCF\]).
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Valsartan/Amlodipine 160/5 mg | Change in Mean Sitting Diastolic Blood Pressure (msDBP) From Baseline to Week 8 | -4.65 mmHg | Standard Error 0.3616 |
| Amlodipine 10 mg | Change in Mean Sitting Diastolic Blood Pressure (msDBP) From Baseline to Week 8 | -4.13 mmHg | Standard Error 0.369 |
Secondary
Change in Mean Sitting Systolic and Diastolic Blood Pressure (msSBP, msDBP) From Baseline to Weeks 4, 8, and 12
Blood pressure (BP) was measured at trough (24±3 hours post-dose). The arm in which the highest sitting diastolic BP was found at study entry was used for all subsequent readings. If there was \< 0. 5 mmHg difference in BP between the 2 arms, the non-dominant arm was used. At each visit, after the patient was in a sitting position with the back supported and both feet placed on the floor for 5 minutes, systolic and diastolic BP were measured 3 times with an automated BP monitor and appropriate size cuff. Means of the 3 measurements were calculated. A negative change indicates lowered BP.
Time frame: Baseline to Weeks 4, 8, and 12
Population: Intent-to-treat (ITT) population: All randomized patients who had a baseline and at least one post-baseline efficacy assessment. For patients who discontinued prior to Week 8, the last post-baseline msSBP measurement collected was used for the analysis (last observation carried forward \[LOCF\]).
| Arm | Measure | Group | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|---|
| Valsartan/Amlodipine 160/5 mg | Change in Mean Sitting Systolic and Diastolic Blood Pressure (msSBP, msDBP) From Baseline to Weeks 4, 8, and 12 | msSBP: Week 4 (n=576, 535) | -8.40 mmHg | Standard Error 0.5559 |
| Valsartan/Amlodipine 160/5 mg | Change in Mean Sitting Systolic and Diastolic Blood Pressure (msSBP, msDBP) From Baseline to Weeks 4, 8, and 12 | msSBP: Week 8 (n=567, 510) | -8.15 mmHg | Standard Error 0.6065 |
| Valsartan/Amlodipine 160/5 mg | Change in Mean Sitting Systolic and Diastolic Blood Pressure (msSBP, msDBP) From Baseline to Weeks 4, 8, and 12 | msSBP: Week 12 (n=569, 531) | -9.08 mmHg | Standard Error 0.6968 |
| Valsartan/Amlodipine 160/5 mg | Change in Mean Sitting Systolic and Diastolic Blood Pressure (msSBP, msDBP) From Baseline to Weeks 4, 8, and 12 | msDBP: Week 4 (n=576, 535) | -5.05 mmHg | Standard Error 0.3559 |
| Valsartan/Amlodipine 160/5 mg | Change in Mean Sitting Systolic and Diastolic Blood Pressure (msSBP, msDBP) From Baseline to Weeks 4, 8, and 12 | msDBP: Week 8 (n=576, 510) | -4.68 mmHg | Standard Error 0.3632 |
| Valsartan/Amlodipine 160/5 mg | Change in Mean Sitting Systolic and Diastolic Blood Pressure (msSBP, msDBP) From Baseline to Weeks 4, 8, and 12 | msDBP: Week 12 (n=569, 531) | -5.50 mmHg | Standard Error 0.03735 |
| Amlodipine 10 mg | Change in Mean Sitting Systolic and Diastolic Blood Pressure (msSBP, msDBP) From Baseline to Weeks 4, 8, and 12 | msDBP: Week 8 (n=576, 510) | -3.97 mmHg | Standard Error 0.3736 |
| Amlodipine 10 mg | Change in Mean Sitting Systolic and Diastolic Blood Pressure (msSBP, msDBP) From Baseline to Weeks 4, 8, and 12 | msSBP: Week 4 (n=576, 535) | -6.48 mmHg | Standard Error 0.5676 |
| Amlodipine 10 mg | Change in Mean Sitting Systolic and Diastolic Blood Pressure (msSBP, msDBP) From Baseline to Weeks 4, 8, and 12 | msDBP: Week 4 (n=576, 535) | -4.23 mmHg | Standard Error 0.3623 |
| Amlodipine 10 mg | Change in Mean Sitting Systolic and Diastolic Blood Pressure (msSBP, msDBP) From Baseline to Weeks 4, 8, and 12 | msSBP: Week 8 (n=567, 510) | -6.11 mmHg | Standard Error 0.6266 |
| Amlodipine 10 mg | Change in Mean Sitting Systolic and Diastolic Blood Pressure (msSBP, msDBP) From Baseline to Weeks 4, 8, and 12 | msDBP: Week 12 (n=569, 531) | -4.90 mmHg | Standard Error 0.3785 |
| Amlodipine 10 mg | Change in Mean Sitting Systolic and Diastolic Blood Pressure (msSBP, msDBP) From Baseline to Weeks 4, 8, and 12 | msSBP: Week 12 (n=569, 531) | -7.82 mmHg | Standard Error 0.7088 |
Secondary
Percentage of Patients Achieving a Systolic Response at Weeks 4, 8, and 12
Systolic response was defined as msSBP \< 130 mmHg or at least a 20 mmHg reduction from baseline in msSBP at Weeks 4, 8, and 12. Blood pressure (BP) was measured at trough (24±3 hours post-dose). The arm in which the highest sitting diastolic BP was found at study entry was used for all subsequent readings. At each visit, after the patient was in a sitting position with the back supported and both feet placed on the floor for 5 minutes, systolic and diastolic BP were measured 3 times with an automated BP monitor and appropriate size cuff. Means of the 3 measurements were calculated.
Time frame: Baseline to Weeks 4, 8, and 12
Population: Intent-to-treat (ITT) population: All randomized patients who had a baseline and at least one post-baseline efficacy assessment. For patients who discontinued prior to Week 8, the last post-baseline msSBP measurement collected was used for the analysis (last observation carried forward \[LOCF\]).
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Valsartan/Amlodipine 160/5 mg | Percentage of Patients Achieving a Systolic Response at Weeks 4, 8, and 12 | Week 4 (n=576, 535) | 35.07 Percentage of patients |
| Valsartan/Amlodipine 160/5 mg | Percentage of Patients Achieving a Systolic Response at Weeks 4, 8, and 12 | Week 8 (n=567, 510) | 34.22 Percentage of patients |
| Valsartan/Amlodipine 160/5 mg | Percentage of Patients Achieving a Systolic Response at Weeks 4, 8, and 12 | Week 12 (n=569, 531) | 37.96 Percentage of patients |
| Amlodipine 10 mg | Percentage of Patients Achieving a Systolic Response at Weeks 4, 8, and 12 | Week 4 (n=576, 535) | 25.42 Percentage of patients |
| Amlodipine 10 mg | Percentage of Patients Achieving a Systolic Response at Weeks 4, 8, and 12 | Week 8 (n=567, 510) | 25.49 Percentage of patients |
| Amlodipine 10 mg | Percentage of Patients Achieving a Systolic Response at Weeks 4, 8, and 12 | Week 12 (n=569, 531) | 31.26 Percentage of patients |