Combination of enalapril and low-dose thiazide reduces normoalbuminuria in essential hypertension.
OBJECTIVE
To examine the effect of the combination of enalapril with a very low dose of hydrochlorothiazide versus atenolol on urinary albumin excretion in normoalbuminuric patients with mild to moderate essential hypertension. A secondary objective was to compare the effects of the two regimens in patients with different levels of albuminuria.


METHODS
A 12 weeks, randomized, double-blind, double-dummy, multicenter, comparative study with two parallel groups.


METHODS
General practices in Denmark and Finland.


METHODS
The subjects comprised 174 patients with mild to moderate essential hypertension, normal serum creatinine and no proteinuria.


METHODS
Enalapril/hydrochlorothiazide (20/6 mg) daily or atenolol (50 mg) daily.


METHODS
Urinary albumin: creatinine ratio and blood pressure.


RESULTS
At baseline, normoalbuminuria was found in 74 and 85 patients in the enalapril/hydrochlorothiazide and atenolol groups, respectively. Blood pressure was reduced similarly by both treatments. The ratio of urinary albumin to creatinine in normoalbuminuric patients was significantly reduced during treatment with enalapril/hydrochlorothiazide at 20/6 mg (from geometic mean x/divided by antilog SD of 0.53 x/divided by 1.77 to 0.47 x/divided by 1.58 mg/mmol, P=0.02) but was unchanged during atenolol treatment (0.55 x/divided by 1.74 and 0.58 x/divided by 1.87 mg/mmol). The difference between the two treatments was statistically significant (P=0.03) and was predominantly achieved through a reduction of albuminuria in the upper-normal range during enalapril/hydrochlorothiazide treatment.


CONCLUSIONS
Therapy with enalapril/hydrochlorothiazide at 20/6 mg and atenolol at 50 mg once daily reduced blood pressure similarly in patients with essential hypertension. Suppression of urinary albumin excretion within the normoalbuminuric range was observed during treatment with enalapril/hydrochlorothiazide at 20/6 mg.
Nielsen
S
S
Medical Department M, Aarhus Kommunehospital, Denmark. nielsen.soren@mayo.edu
Dollerup
J
J
Nielsen
B
B
Mogensen
C E
CE
D000419:Albuminuria / Q000188:drug therapy* / Q000209:etiology / Q000652:urine; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D003404:Creatinine / Q000652:urine; D004232:Diuretics; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004656:Enalapril / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000008:administration & dosage / Q000627:therapeutic use*; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D049993:Sodium Chloride Symporter Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*
D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics; D049993:Sodium Chloride Symporter Inhibitors; D006852:Hydrochlorothiazide; D004656:Enalapril; D003404:Creatinine