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Equivalent antihypertensive effects of combination therapy using diuretic + calcium antagonist compared with diuretic
W J Elliott1, T B Polascik, M B Murphy
1Committee on Clinical Pharmacology, University of Chicago, IL 60637.
Insights
Combining calcium antagonists with diuretics is as effective for lowering blood pressure (BP) as using ACE inhibitors with diuretics. Both combinations significantly reduce BP compared to monotherapy.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
Background:
- Hypertension management often involves combination therapy.
- Understanding the comparative efficacy of different antihypertensive drug combinations is crucial for clinical practice.
Purpose of the Study:
- To compare the effectiveness of calcium antagonist plus diuretic versus ACE inhibitor plus diuretic in lowering blood pressure (BP).
- To test the hypothesis that calcium antagonist-diuretic combinations are less effective than ACE inhibitor-diuretic combinations.
Main Methods:
- Two groups of hypertensive patients were studied.
- Group 1: 157 patients had therapy adjusted with calcium antagonist or diuretic (each patient served as own control).
- Group 2: 170 patients had therapy adjusted with ACE inhibitor or diuretic.
- Blood pressure (BP) changes were measured after therapy adjustments.
Main Results:
- Calcium antagonist + diuretic combination lowered supine BP by 13.4/5.4 mmHg and standing BP by 13.2/5.6 mmHg.
- ACE inhibitor + diuretic combination lowered supine BP by 12.3/8.0 mmHg and standing BP by 12.3/7.0 mmHg.
- No significant differences in BP reduction were observed between the two combination therapies.
Conclusions:
- Both calcium antagonist-diuretic and ACE inhibitor-diuretic combinations are effective in lowering BP.
- The combination of calcium antagonist plus diuretic is as effective as the ACE inhibitor plus diuretic combination for BP reduction.
- Both combinations are more effective than monotherapy.
Abstract:
To test the hypothesis that the combination of a calcium antagonist and diuretic is less effective in lowering BP than the combination of ACE inhibitor plus diuretic, we compared two groups of patients. The first was a group of 157 consecutive patients (32% male, 90% black, aged 57 +/- 1 years) in whom the only change in therapy was the addition or deletion of either a calcium antagonist or diuretic. Each patient served as his/her own control, with a follow-up time of 41 +/- 4 days. The BP responses of this group were compared with those of another group of 170 consecutive patients (33% male, 85% black, aged 55 +/- 1 years), who had had the addition or deletion of an ACE inhibitor or diuretic some 32 +/- 2 days previously. As there were no statistically significant differences either between drugs within the classes or between the addition or deletion of a drug, the BP results were pooled. Combination therapy with calcium antagonist + diuretic was associated with a 13.4 +/- 1.7/5.4 +/- 0.9 mmHg drop in supine BP; the ACE inhibitor + diuretic combination lowered supine BP by 12.3 +/- 1.6/8.0 +/- 0.9 mmHg compared with monotherapy (all P less than 0.001 by paired t-test). The effects on standing BP were similar: calcium antagonist + diuretic, 13.2 +/- 1.9/5.6 +/- 0.9 mmHg; and ACE inhibitor + diuretic, 12.3 +/- 1.5/7.0 +/- 0.9 mmHg (all P less than 0.001). There were no significant differences in BP responses between the calcium antagonist + diuretic and ACE inhibitor + diuretic combinations. These data indicate that, regardless of the order of addition or subtraction, the combination of calcium antagonist + diuretic was more effective in lowering BP than either agent used alone, and that the combination of calcium antagonist + diuretic was as effective as the ACE inhibitor + diuretic combination.