Combo AIds Hypertensives with LUTS

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Low-dose amlodipine added to terazosin appears to be safe and effective for treating both hypertension and lower urinary tract symptoms (LUTS) in Chinese men, investigators reported.

They studied 355 men with stage 1 or 2 hypertension and LUTS, as defined by an International Prostate Symptom Score (IPSS) of 10 or higher). Subjects had a mean age of 63 years.

The researchers randomly assigned 117 men to receive 2 mg terazosin, 119 men to receive 5 mg amlodipine, and 119 to receive 5 mg of amlodipine plus 2 mg terazosin once daily for 28 days.

At day 28, the amlodipine group had achieved a similar reduction in total IPSS from baseline compared with the terazosin group (6.9 vs. 6.7), according to findings published in Urology (2009;74:130-136). The amlodipine monotherapy arm had a similar decrease in bladder outlet obstruction (BOO) subscore (4.0 vs. 4.1), overactive bladder (OAB) subscore (2.9 vs. 2.6), and quality of life score (1.1 vs. 1.2) compared with the terazosin group.

The combination-treatment arm had a significantly greater reduction in QOL score (1.4 vs. 1.1) compared with the amlodipine arm. All three study arms had similar reductions in total IPSS, BOO subscore, and OAB subscore.

The mean reduction in systolic BP and diastolic BP from baseline in the amlodipine gropu was significantly greater than that of the terazosin group (21.8/10 vs. 11.9/6.5 mm Hg). The biggest reduction in SBP and DBP (25.2/12.6 mm Hg) was observed in the combination arm and this was significantly greater than that of either monotherapy arm.

Overall, the three treatment arms had similar proportions of responders, defined as patients who had at least a 40% reduction in total IPSS, BOO subscore, OAB subscore, or QOL score, or a total IPSS of less than 8 at day 28.

When the researchers considered OAB subscore alone, the combination-treatment arm had a significantly greater proportion of responders (patients who had a 40% reduction in subscore) than the terazosin monotherapy group (53.8% vs. 39.3). With respect to QOL score, the combination-treatment group had a significantly greater proportion of responders than the amlodipine group (47.1% vs. 33.6%).

“We speculate that this combination therapy might be particularly useful for male hypertensive patients with predominantly OAB symptoms,” the authors concluded.

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