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Seasonal variation in the effect of antihypertensive treatment with the irbesartan/hydrochlorothiazide combination

Hypertension Research volume 46, pages 507–515 (2023)Cite this article

A Comment to this article was published on 28 December 2022

Abstract

There is increasing awareness of seasonal variation in blood pressure (BP). In the present analysis, we investigated seasonal variation in the antihypertensive treatment effect of the irbesartan/hydrochlorothiazide combination in patients with stage 2 and 3 hypertension. The study participants were hypertensive patients enrolled in a 12-week therapeutic study. Antihypertensive treatment was initiated with irbesartan/hydrochlorothiazide 150/12.5 mg/day, with possible uptitration to 300/12.5 mg/day and 300/25 mg/day at 4 and 8 weeks of follow-up, respectively. The month of treatment commencement was classified as spring/summer (May to August) and autumn/winter (September to December). Of the 501 enrolled patients, 313 and 188 commenced antihypertensive treatment in spring/summer and autumn/winter, respectively. The mean changes in systolic/diastolic BP at 8 and 12 weeks of follow-up were greater in patients who commenced treatment in autumn/winter (−32.3/−16.5 and −34.2/−16.7 mmHg, respectively) than those who commenced treatment in spring/summer (−28.4/−13.9 and −27.1/−12.8 mmHg, respectively), with a between-season difference of 3.9 (95% confidence interval [CI], 1.4–6.4, P = 0.002)/2.6 (95% CI, 0.9–4.2, P = 0.002) mmHg and 7.0 (95% CI, 4.7–9.3, P < 0.0001)/3.9 (95% CI, 2.4–5.4, P < 0.0001) mmHg, respectively. Further subgroup analyses according to several baseline characteristics showed a greater between-season difference in the changes in systolic BP in patients aged ≥55 years than in those <55 years (n = 255, 12.6 mmHg vs. n = 246, 6.9 mmHg, P = 0.02), especially in patients who did not use antihypertensive medication at baseline (n = 94, 15.4 mmHg vs. n = 132, 5.4 mmHg, P = 0.006). In conclusion, there is indeed seasonality in the antihypertensive treatment effect, with a greater BP reduction in patients who commenced treatment in cold than warm seasons.

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Acknowledgements

The authors gratefully acknowledge the participation of the patients and the contribution of the investigators from 18 participating hospitals. For detailed information on the participating hospitals, please refer to reference [13].

Funding

The study was funded and sponsored by Sanofi China (Shanghai). YL and J-GW were also financially supported by grants from the National Natural Science Foundation of China (grants 81770455, 82070432 and 82070435), Ministry of Science and Technology (2018YFC1704902) and Ministry of Health (grant 2016YFC0900902), Beijing, China; from the Shanghai Commissions of Science and Technology (grant 19DZ2340200) and Health (“Three-year Action Program of Shanghai Municipality for Strengthening the Construction of Public Health System” GWV-10.1-XK05 and a special grant for ‘leading academics’) Shanghai, China; and from the Clinical Research Program, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine (grant 2018CR010), Shanghai, China.

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Authors and Affiliations

  1. School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Xiao-Fei Ye & Ji-Guang Wang

  2. Department of Cardiovascular Medicine, Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Qi-Fang Huang, Yan Li & Ji-Guang Wang

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  1. Xiao-Fei Ye
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  2. Qi-Fang Huang
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Correspondence to Ji-Guang Wang.

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J-GW reports receiving consulting and lecture fees from Novartis, Omron, and Servier. The other authors declare no conflicts of interest.

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Ye, XF., Huang, QF., Li, Y. et al. Seasonal variation in the effect of antihypertensive treatment with the irbesartan/hydrochlorothiazide combination. Hypertens Res 46, 507–515 (2023). https://doi.org/10.1038/s41440-022-01084-y

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