Combination therapy of ARB with diuretics in Japanese hypertensive patients

The new guideline for the management of hypertension issued by the Japanese Society of Hypertension (JSH2009) emphasizes strict blood pressure (BP) control. Ca channel blockers (CCB) and angiotensin receptor blockers (ARB) are mainly used in Japan, while BP control status remains insufficient. Since the achievement of salt restriction to less than 6 g/day is difficult in Japanese hypertensive patients, the use of low dose diuretics is useful. To minimize metabolic side effects of diuretics, combination therapy with ARB or ACE inhibitors is warranted. Losartan/HCTZ combination tablets effectively reduce BP when switched from the usual dose of ARB or ACE inhibitors. Since losartan has a property to increase urinary uric acid excretion, it may offset the increase in serum uric acid induced by the use of HCTZ. Metabolic disorders including diabetes, dyslipidemia and hyperuricemia are commonly prevalent in hypertensive patients. Thus, strict BP control utilizing appropriate combination therapy and the concomitant control of other metabolic risk factors are important to prevent cardiovascular events.