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Enalapril and hydrochlorothiazide as antihypertensive agents in the elderly
D A Shapiro1, C L Liss, J F Walker
1Department of Clinical Research (Cardiovascular), Merck Sharpe & Dohme Research Laboratories, West Point, Pennsylvania 19486.
Insights
Enalapril and hydrochlorothiazide (HCTZ) effectively lower blood pressure in elderly patients with hypertension. Both medications demonstrated comparable efficacy and good tolerability in this study.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Clinical Pharmacology
Background:
- Hypertension is a prevalent condition in the elderly, increasing cardiovascular risk.
- Effective blood pressure management is crucial for preventing complications in older adults.
- Comparative studies of antihypertensive agents in this demographic are essential for guiding treatment decisions.
Purpose of the Study:
- To compare the antihypertensive efficacy and tolerability of enalapril versus hydrochlorothiazide (HCTZ) in elderly patients.
- To evaluate the effectiveness of these agents in both essential hypertension (EH) and isolated systolic hypertension (ISH).
Main Methods:
- A randomized, double-blind, placebo-controlled study involving 174 elderly patients.
- Patients received either enalapril or HCTZ, with dose adjustments and potential addition of the other drug if blood pressure remained uncontrolled.
- Blood pressure measurements were taken at baseline, 8 weeks, and at the end of the study.
Main Results:
- Both enalapril and HCTZ significantly reduced systolic and diastolic blood pressure in the elderly population (p ≤ 0.01).
- Mean blood pressures at study end were comparable between enalapril (144/83 mm Hg) and HCTZ (145/83 mm Hg).
- Caucasian patients showed a greater systolic blood pressure reduction with enalapril after 4 weeks (p ≤ 0.05).
Conclusions:
- Enalapril and HCTZ are both effective antihypertensive treatments for elderly individuals.
- The drugs were generally well-tolerated, with no significant difference in laboratory adverse experiences.
- Both agents offer a valuable therapeutic option for managing hypertension in the elderly population.
Abstract:
This randomized, double blind study compared the antihypertensive effects of enalapril to hydrochlorothiazide (HCTZ) in the elderly. One hundred seventy-four patients with diastolic blood pressures (DBP) of 90-120 mm Hg or isolated systolic hypertension (ISH) (systolic BP greater than 160 mm Hg and diastolic BP less than 90 mm Hg) were studied. After four weeks of placebo, patients received either enalapril 10 mg or HCTZ 12.5 mg once daily. If the BP was uncontrolled (DBP greater than 85 mm Hg or SBP greater than 140 mm Hg) after 4 weeks, the dose was doubled. At 8 weeks, if necessary, the other drug could be added at the lower dose, then doubled 4 weeks later. Two-thirds of the patients had essential hypertension (EH), the rest ISH; 68% were male and 80% Caucasian. The baseline BPs were 167/94 mm Hg in both groups, at 8 weeks the mean BPs were 148/85 mm Hg in both groups (p less than or equal to 0.01), and at the end of the study the BPs with enalapril were 144/83 mm Hg and with HCTZ they were 145/83 mm Hg (p less than or equal to 0.01). The Caucasians showed greater BP falls on enalapril than HCTZ after 4 weeks (p less than or equal to 0.05). The SBP falls for the ISH (-22 mm Hg) and EH (-23 mm Hg) groups were similar at the end of the study. Both drugs were generally well tolerated. Laboratory adverse experiences (AEs) were 9% more common in the HCTZ patients (n.s.). Enalapril and HCTZ both seem to be effective antihypertensive agents in the elderly.