title: Efficacy of ramipril versus enalapril in patients with mild to moderate essential hypertension.
abstract: This double-blind, randomised, cross-over study investigated the antihypertensive efficacy of ramipril and enalapril was completed by 30 patients with mild-to-moderate essential hypertension. After a four-week placebo run-in phase, the patients received either 2.5mg ramipril or 10mg enalapril once daily for four weeks. The dosages were increased to 5mg ramipril and 20mg enalapril for a further four weeks. After a placebo washout phase of four weeks, the patients were crossed over to the alternative treatment. The decrease in average 24-hour ambulatory diastolic blood pressure from week 0 to week 8 was 1.6mmHg greater with ramipril than enalapril (90% confidence interval 0.6-2.7mmHg). The corresponding reduction in for systolic blood pressure was also greater with ramipril than enalapril by 2.4mmHg (90% confidence interval: 0.5-4.2mmHg). For the difference in the drop of 24-hour ambulatory diastolic blood pressure between ramipril and enalapril the lower level of the 90% confidence interval (CI) is above the clinically relevant difference of -3mmHg. This is an indication that ramipril (2.5 and 5mg dose) is at least as effective as enalapril (10 and 20mg dose) in decreasing blood pressure in patients with mild-to-moderate essential hypertension. The duration of adequate antihypertensive effect was relatively long for both ramipril and enalapril; however, ramipril tended to have a more prolonged antihypertensive effect. Ramipril had a higher diastolic and systolic trough/peak ratio than enalapril, resulting in a more uniform antihypertensive effect over the 24-hour treatment period. Both ramipril and enalapril were well tolerated and the two treatment groups had similar safety profiles.
authors.affiliation: Departamento de Medicina Interna, Universidad Nacional de Cuyo, Mendoza, Argentina.
authors.forename: J
authors.initials: J
authors.lastname: Yasky
authors.forename: M
authors.initials: M
authors.lastname: Verho
authors.forename: T P
authors.initials: TP
authors.lastname: Erasmus
authors.forename: H G
authors.initials: HG
authors.lastname: Luus
authors.forename: M
authors.initials: M
authors.lastname: Angela
authors.forename: L
authors.initials: L
authors.lastname: Grandin
authors.forename: M A
authors.initials: MA
authors.lastname: Akbary
authors.forename: B
authors.initials: B
authors.lastname: Rangoonwala
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004656:Enalapril / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017257:Ramipril / Q000627:therapeutic use
chemical_list: D000959:Antihypertensive Agents; D004656:Enalapril; D017257:Ramipril