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[Definition and consequences of blocking the renin-angiotensin system by converting enzyme inhibition]
P Sassano1, G Chatellier, E Billaud
1Service d'Hypertension artérielle, hôpital Broussais, Paris.
Insights
Adding hydrochlorothiazide to enalapril significantly lowers blood pressure more effectively than increasing enalapril dosage alone for patients with hypertension.
Area of Science:
- Cardiology
- Pharmacology
- Hypertension Management
Background:
- Hypertension affects millions globally, necessitating effective treatment strategies.
- Enalapril is a common angiotensin-converting enzyme inhibitor used for hypertension.
- Optimizing antihypertensive regimens is crucial for patient outcomes.
Purpose of the Study:
- To compare the efficacy of escalating enalapril dosage versus a combination of enalapril and hydrochlorothiazide in patients with uncontrolled hypertension.
- To evaluate blood pressure reduction in hypertensive patients receiving two different treatment regimens.
Main Methods:
- A randomized study involving 46 patients with diastolic blood pressure > 90 mmHg after initial enalapril treatment.
- Patients were assigned to either higher-dose enalapril (ENA group) or enalapril plus hydrochlorothiazide (HCTZ group).
- Blood pressure was monitored using an automated oscillometric device and a standard sphygmomanometer over a 4-week period.
Main Results:
- The hydrochlorothiazide group (HCTZ) showed significantly lower blood pressure readings compared to the enalapril-only group (ENA).
- Automated device readings: HCTZ group 130/80 mmHg vs. ENA group 141/86 mmHg (p<0.01/p<0.05).
- Sphygmomanometer readings: HCTZ group 134/89 mmHg vs. ENA group 149/94 mmHg (p<0.001/p<0.01).
Conclusions:
- Combination therapy with enalapril and hydrochlorothiazide is more effective in reducing blood pressure than increasing enalapril dosage alone.
- Hydrochlorothiazide addition provides superior blood pressure control in patients with persistent hypertension.
- This combination therapy represents a valuable strategy for managing difficult-to-control hypertension.
Abstract:
46 patients (39 males), mean age 51 years (range 33-66), were randomly allocated to two different groups of treatment if their diastolic blood pressure was superior to 90 mmHg after a one-month treatment by 20 mg of enalapril. In the first group (ENA), 23 patients were given higher dosages of enalapril (40 and, if necessary 60 mg once-a-day). In the second group (HCTZ) 23 patients were given enalapril 20 mg and hydrochlorothiazide 25 and, if necessary, 50 mg once-a-day. Dosages were eventually increased after 2 weeks and evaluation of the results was performed after 4 weeks on treatment. Blood pressure was monitored in the supine position, at 3 minutes interval for thirty minutes, by an automatic device based on oscillometric method. Two successive measurements with a standard sphygmomanometer were performed by the physician at the end of the recording. No patient withdrew from the study nor was lost to follow-up. At the end of the study, 14 patients in the ENA group were receiving enalapril 60 mg once-a-day and 8 patients in the HCTZ group were receiving 50 mg of hydrochlorothiazide. Blood pressure was significantly lower in teh HCTZ group with the automatic device (130 +/- 9/80 +/- 8 vs 141 +/- 5/86 +/- 8 mmHg, p less than 0.01/p less than 0.05) and with the sphygmomanometer (134 +/- 10/89 +/- 6 vs 149 +/- 16/94 +/- 5 mmHg, p less than 0.001/p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)