Combination of amlodipine and enalapril in hypertensive patients with coronary disease.
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.
Rienzo
Marcos
M
Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
Saraiva
José Francisco Kerr
JF
Nogueira
Paulo Roberto
PR
Gomes
Everli Pinheiro de Souza Gonçalves
EP
Moretti
Miguel Antonio
MA
Ferreira
João Fernando Monteiro
JF
Armagnajian
Dikran
D
Mansur
Antonio de Pádua
Ade P
Ramires
José Antonio Franchini
JA
César
Luiz Antonio Machado
LA
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
D000959:Antihypertensive Agents; D017311:Amlodipine; D004656:Enalapril