The treatment of mild to moderate hypertension with ACE inhibitors

The efficacy and safety of quinapril were evaluated in patients with mild to moderate hypertension [sitting diastolic blood pressure (DBP) of 95-115 mm Hg] in seven large, multicenter studies and in one large, single-center study. In double-blind trials, 1,367 patients were treated with quinapril and 820 patients were treated with comparative therapies (enalapril, captopril, chlorthalidone, or placebo). The usual effective dosage of quinapril was 10-40 mg/day, with some patients receiving up to 80 mg/day. Diuretics were added optionally for nonresponders in some studies. Quinapril was equally safe and effective administered either once daily (o.d.) or twice daily and was significantly more effective in lowering blood pressure than was placebo. Quinapril and enalapril administered o.d. were similarly effective in producing clinically and statistically significant reductions in resting blood pressure 24 h after dosing. Quinapril in o.d. doses was as effective as captopril administered two or three times daily. Quinapril was well tolerated; the incidence of adverse events was similar to that for placebo and was comparable to or less than that reported for captopril or enalapril. Quinapril in o.d. doses (10-40 mg/day) is safe and effective as first-line therapy for the treatment of mild to moderate hypertension. Diuretics can be safely added for patients who are not controlled by quinapril alone.