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Eprosartan versus enalapril in elderly patients with hypertension: a double-blind, randomized trial
L Ruilope1, B Jäger, B Prichard
1Hypertension Unit, Madrid, Spain.
Insights
Eprosartan and enalapril equally reduce systolic blood pressure in elderly patients with hypertension. Eprosartan showed better tolerability, with significantly less dry cough compared to enalapril.
Area of Science:
- Cardiology
- Geriatrics
- Pharmacology
Background:
- Essential hypertension is a prevalent condition in elderly populations.
- Effective blood pressure management is crucial for reducing cardiovascular risk in older adults.
- Comparative studies of antihypertensive medications are vital for clinical decision-making.
Purpose of the Study:
- To compare the efficacy of eprosartan versus enalapril in lowering systolic blood pressure.
- To assess the safety and tolerability profiles of eprosartan and enalapril in elderly hypertensive patients.
- To evaluate treatment response rates and adverse event incidence in both drug groups.
Main Methods:
- A randomized, double-blind study involving 334 elderly patients (>65 years) with essential hypertension.
- Patients received either eprosartan (600-800 mg once daily) or enalapril (5-20 mg once daily) for 12 weeks.
- Flexible dose titration aimed to achieve a sitting systolic blood pressure below 140 mmHg; primary outcome was change in sitting systolic blood pressure.
Main Results:
- Both eprosartan and enalapril demonstrated similar reductions in sitting systolic blood pressure (mean change -18.0 vs. -17.4 mmHg) and sitting diastolic blood pressure (-9.4 vs. -9.6 mmHg).
- Blood pressure normalization and response rates were comparable between the eprosartan and enalapril groups.
- Adverse events occurred in 35.7% of eprosartan patients versus 50.9% of enalapril patients, with significantly less dry cough reported with eprosartan.
Conclusions:
- Eprosartan and enalapril are equally effective in reducing systolic and diastolic blood pressure in elderly patients with essential hypertension.
- Eprosartan is better tolerated than enalapril, particularly due to a lower incidence of dry cough.
- These findings support eprosartan as a well-tolerated alternative for managing hypertension in the elderly.
Aim:
To compare the efficacy and safety of eprosartan and enalapril to lower systolic blood pressure in elderly patients with essential hypertension.
Methods:
334 patients >65 years with sitting systolic blood pressure (sitSBP) > or = 160 mmHg and diastolic blood pressure (sitDBP) 90-114 mmHg were randomized to 12 weeks of double-blind treatment with eprosartan, 600-800 mg once daily (o.d.) or enalapril (5-20 mg o.d.), with flexible dose titration to lower systolic blood pressure below 140 mmHg. The primary outcome measure was change in sitSBP at endpoint.
Results:
Least-squares mean changes from baseline in sitSBP were -18.0 and -17.4 mmHg in the eprosartan and enalapril groups, respectively (difference eprosartan-enalapril -0.6, 95% confidence interval, CI, -4.1 to 3.0, p = 0.76). The corresponding figures for sitDBP were -9.4 and -9.6 mmHg (difference eprosartan-enalapril 0.2, 95% CI -1.7 to 2.0, p = 0.84). Normalization and response rates were also similar in the two groups. Adverse events were recorded in 61 (35.7%) patients on eprosartan (one with dry cough) and 83 (50.9%) patients on enalapril (10 with dry cough).
Conclusions:
Eprosartan and enalapril were equally effective in reducing sitSBP and sitDBP in elderly patients with predominantly systolic hypertension. Eprosartan was better tolerated and, in particular, lacked the propensity of enalapril to cause dry cough.