Amlodipine combined with perindopril or hydrochlorothiazide was superior to perindopril plus hydrochlorothiazide for lowering both ambulatory and office blood pressure (BP) in black Africans, according to results of the CREOLE trial presented at ACC.19 in New Orleans and simultaneously published in the New England Journal of Medicine.

Two-drug combinations are usually required for BP control in black Africans, yet the most effective combination has not been established. Evidence shows that diuretics or calcium-channel blockers are the most effective monotherapies. In the CREOLE trial, Dike Ojji, PhD, et al., randomized 728 patients with hypertension to daily amlodipine (5 mg) plus hydrochlorothiazide (12.5 mg); amlodipine (5 mg) plus perindopril (4 mg); or perindopril (4 mg) plus hydrochlorothiazide (12.5 mg). After two months, the doses were doubled.

Ambulatory BP (24-hour) was measured at baseline and six months. Office BP was measured at baseline and at two, four and six months during follow-up visits. The primary endpoint was the mean change in the 24-hour ambulatory systolic BP between baseline and six months.

Of the randomized patients, 621 completed the study and had ambulatory BP measurements at study end. After six months, ambulatory systolic BP was reduced from baseline by 18.1 mm Hg with amlodipine plus perindopril and by 17.1 mm Hg with amlodipine plus hydrochlorothiazide compared with 14.2 mm Hg with perindopril plus hydrochlorothiazide.

Adjusted results showed a significant difference with amlodipine plus hydrochlorothiazide (p=0.03) and amlodipine plus perindopril (p=0.04). Patients receiving amlodipine plus hydrochlorothiazide or amlodipine plus perindopril had greater reductions in office systolic BP at two, four and six months.

"In black patients in sub-Saharan Africa, the combination regimens amlodipine plus hydrochlorothiazide and amlodipine plus perindopril were significantly more effective than perindopril plus hydrochlorothiazide at reducing average 24-hour ambulatory systolic blood pressure over a six-month period, the study's primary endpoint," said Ojji.

Keywords: ACC19, ACC Scientific Session Newspaper, Combined Modality Therapy, Primary Prevention

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