[Cilazapril replacing captopril in the therapy of medium-severe essential hypertension]

Authors performed an open, crossover, multicenter study of oral cilazapril versus previous captopril treatment in mild to moderate hypertension. The treatment of the 100 outpatients on daily three or four times captopril was found ineffective, or in some cases side effects or non compliance necessitated a switch to a once daily dose of cilazapril. Reasons of ineffectivity were compliance problems in 76% of the patients during long term captopril therapy. Blood pressure decreased from 163.28 +/- 14.5/97.5 +/- 9.35 mmHg on captopril therapy to 136.67 +/- 12/83.49 +/- 7.77 mmHg at the end of a 12 week cilazapril treatment (p < 0.001). 80 patients received cilazapril monotherapy (with doses of 2.5 mg in 54 cases, 5 mg in 18 patients). 7.5 mg in 4 cases, 1 and 1.25 mg in 2 patients. In 20 patients an adjunctive diuretic was also added, while the cilazapril treatment was ineffective in 3 patients. In respect of the global evaluation and scoring of cilazapril versus captopril therapy, a clear and statistically significant improvement could be demonstrated in efficacy, tolerability and compliance after a 12 week cilazapril treatment. The 24 hour ambulatory blood pressure measurement performed in 13 patients also verified a decrease in blood pressure achieved by cilazapril therapy. Authors conclude that in case of ineffectivity of three or four times daily captopril treatment (caused most likely by non-compliance), a switch to a once daily dose drug like cilazapril is indicated.