Evaluation of the efficacy and safety of enalapril plus hydrochlorothiazide plus methyldopa vs standard triple therapy in the treatment of moderate to severe hypertension: results from a multicentre study.
We report the results of a randomized, double-blind, parallel group multicentre study in 120 patients with moderate to severe hypertension, comparing two different types of antihypertensive treatment: a) the standard 'triple therapy' with hydrochlorothiazide, propranolol and hydralazine, and b) the combination of an ACE inhibitor, enalapril with hydrochlorothiazide (HCTZ) and methyldopa. The two regimens caused similar degrees of blood pressure reductions. The only significant difference between the two groups was heart rate due to the bradycardiac effect of propranolol in the group treated with the standard 'triple therapy'. Only 3.4% of patients receiving the regimen of enalapril, HCTZ and methyldopa were withdrawn from the study for adverse reactions, against 10% of patients on HCTZ, propranolol and hydralazine. Four cases of hypokalaemia in the enalapril group and 19 in the propranolol group were reported: so enalapril seemed to ameliorate the hypokalaemic effect of HCTZ. The overall analysis of the study results shows that the treatment based on enalapril, HCTZ and methyldopa is as efficient and better tolerated than the established regimen of HCTZ, propranolol and hydralazine.
Institute of Clinica Medica, University of Milan, Italy.
G
G
Leonetti
C
C
Cuspidi
L
L
Sampieri
E
E
Ambrosioni
P L
PL
Malini
A
A
Pessina
A
A
Semplicini
G
G
Cinotti
S
S
Morabito
A
A
Rappelli
D001794:Blood Pressure / Q000187:drug effects; D004311:Double-Blind Method; D004341:Drug Evaluation; D004359:Drug Therapy, Combination; D004656:Enalapril / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006830:Hydralazine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006852:Hydrochlorothiazide / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008750:Methyldopa / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D011433:Propranolol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic
D006852:Hydrochlorothiazide; D006830:Hydralazine; D008750:Methyldopa; D004656:Enalapril; D011433:Propranolol