title: Combination of amlodipine and enalapril in hypertensive patients with coronary disease.
abstract: BACKGROUND
  Patients (pts) with stable coronary artery disease (CAD) can benefit from a decrease in the blood pressure (BP), according to recent studies.
  
  
  OBJECTIVE
  To evaluate the efficacy and tolerability of the fixed combination: amlodipine + enalapril, when compared to amlodipine in the normalization of the diastolic arterial pressure (DAP) (<85 mmHg), in pts with CAD and systemic arterial hypertension (SAH).
  
  
  METHODS
  Double-blind and randomized study, with two groups of pts with DAP > or =90 and <110 mmHg and CAD. Patients with left ventricular ejection fraction (LVEF) < 40%, symptoms of heart failure or angina class III and IV, severe diseases and DAP > or =110 mmHg during the four-week wash-out with atenolol treatment alone, were excluded. After the wash-out, pts were randomly distributed for the use of the combination (A) or amlodipine (B) and were followed every four weeks up to 98 days. The initial doses (in mg) were, respectively: A- 2.5/10 and B- 2.5; the doses were increased when DAP > 85mmHg, at the visits. Statistical analysis was carried out with chi2, Fischer and analysis of variance, for p< 0.05.
  
  
  RESULTS
  Of the 110 selected pts, 72 (A= 32, B= 40) were randomized. The decreases in DAP and systolic arterial pressure (SAP) were significant (p< 0.01), but with no difference between the groups in mmHg: SAP, A (127.7 +/- 13.4) and B (125.3 +/- 12.6) (p= 0.45) and DAP, A (74.5 +/- 6.7 mmHg) and B (75.5 +/- 6.7 mmHg) (p= 0.32). Group A presented a lower incidence of lower-limb edema: (7.1% vs 30.6%, p=0.02) on the 98th day of follow-up.
  
  
  CONCLUSIONS
  The fixed combination of enalapril and amlodipine, as well as isolated amlodipine, was effective in the normalization of BP in pts with CAD and SAH stages I and II, adding blockage of the renin-angiotensin system.
authors.affiliation: Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors.forename: Marcos
authors.initials: M
authors.lastname: Rienzo
authors.forename: José Francisco Kerr
authors.initials: JF
authors.lastname: Saraiva
authors.forename: Paulo Roberto
authors.initials: PR
authors.lastname: Nogueira
authors.forename: Everli Pinheiro de Souza Gonçalves
authors.initials: EP
authors.lastname: Gomes
authors.forename: Miguel Antonio
authors.initials: MA
authors.lastname: Moretti
authors.forename: João Fernando Monteiro
authors.initials: JF
authors.lastname: Ferreira
authors.forename: Dikran
authors.initials: D
authors.lastname: Armagnajian
authors.forename: Antonio de Pádua
authors.initials: Ade P
authors.lastname: Mansur
authors.forename: José Antonio Franchini
authors.initials: JA
authors.lastname: Ramires
authors.forename: Luiz Antonio Machado
authors.initials: LA
authors.lastname: César
mesh_terms: D017311:Amlodipine / Q000008:administration & dosage* / Q000009:adverse effects; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D003327:Coronary Disease / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D004487:Edema / Q000139:chemically induced; D004656:Enalapril / Q000008:administration & dosage* / Q000009:adverse effects; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D035002:Lower Extremity / Q000473:pathology; D008297:Male; D008875:Middle Aged
chemical_list: D000959:Antihypertensive Agents; D017311:Amlodipine; D004656:Enalapril