title: Effectiveness and tolerability of fixed-dose combination enalapril plus nitrendipine in hypertensive patients: results of the 3-month observational, post-marketing, multicentre, prospective CENIT study.
abstract: OBJECTIVE
  Monotherapy with any class of antihypertensive drug effectively controls blood pressure (BP) in only about 50% of patients. Consequently, the majority of patients with hypertension require combined therapy with two or more medications. This study aimed to evaluate the effectiveness (systolic BP [SBP]/diastolic BP [DBP] control) and tolerability of the fixed-dose combination enalapril/nitrendipine 10 mg/20 mg administered as a single daily dose in hypertensive patients.
  
  
  METHODS
  This was a post-authorization, multicentre, prospective, observational study conducted in primary care with a 3-month follow-up. Patients throughout Spain with uncontrolled hypertension (> or =140/90 mmHg for patients without diabetes mellitus, or > or =130/85 mmHg for patients with diabetes) on monotherapy or with any combination other than enalapril + nitrendipine, or who were unable to tolerate their previous antihypertensive therapy, were recruited. Change from previous to study treatment was according to usual clinical practice. BP was measured once after 5 minutes of rest in the sitting position. Therapeutic response was defined as follows: 'controlled' meant controlled BP (<140/90 mmHg for nondiabetic patients, or <130/85 mmHg for diabetic patients); 'response' meant controlled BP, or a decrease in SBP of > or =20 mmHg and in DBP of > or =10 mmHg. The main laboratory test parameters were documented at baseline and after 3 months. Patients aged >65 years, with diabetes, with isolated systolic hypertension (ISH; SBP > or =140 mmHg for patients without diabetes, SBP > or =130 mmHg for patients with diabetes) and who were obese (body mass index [BMI] > or =30 kg/m2) were analysed separately.
  
  
  RESULTS
  Of 6537 patients included, 5010 and 6354 patients were assessed in effectiveness and tolerability analyses, respectively. In the tolerability analysis population, there were 3023 men (47.6%) and 3321 women (52.4%). The mean (+/- SD) age of the tolerability analysis group was 62.8 (+/- 10.7) years. A total of 71.1% of the patients presented at least one clinical cardiovascular risk factor other than hypertension, with the most frequent being dyslipidaemia (42.3%), obesity (29.2%) and diabetes (23.9%). After 3 months of treatment, SBP and DBP showed mean (+/- SD) decreases of 26.5 (+/- 14.4) mmHg and 14.9 (+/- 9.0) mmHg, respectively, and 73.0% of patients responded to treatment while 40.9% achieved BP control (70.8%/36.1% in 2658 patients aged >65 years; 61.7%/46.8% in 1521 patients with diabetes; 55.3%/44.2% in 731 patients with ISH; 72.0%/36.4% in 1762 obese patients). Adverse events were reported in 10.8% of patients (n = 689). During the follow-up period, ten patients died and seven patients had serious adverse events; in no case was a causal relationship attributed to the study product.
  
  
  CONCLUSIONS
  The rate of SBP/DBP control achieved demonstrates the effectiveness of the fixed-dose enalapril/nitrendipine 10 mg/20 mg combination administered as a single daily dose in patients with essential hypertension not adequately controlled with monotherapy or with any combination other than enalapril + nitrendipine. The proportion and type of adverse events reported were as expected and have already been described for both components of the enalapril/nitrendipine 10 mg/20 mg combination. These results confirm the effectiveness of a strategy based on a fixed-dose enalapril/nitrendipine 10 mg/20 mg combination in reducing BP and achieving BP control goals.
authors.affiliation: Hypertension Unit, Hospital Clinic Barcelona, C/ Villarroel, 170., 08036, Barcelona, Spain. asierra@Clinic.Ub.Es.
authors.forename: Alejandro de la
authors.initials: A
authors.lastname: Sierra
authors.affiliation: Hypertension Unit, Hospital De la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Roca-Cusachs
authors.affiliation: Internal Medicine Department, Hospital Clínico Valencia University of Valencia, Valencia, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Redón
authors.affiliation: Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Marín
authors.affiliation: Hypertension Unit, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Luque
authors.affiliation: La Mina Primary Health Care Centre, Barcelona, Spain.
authors.forename: Mariano de la
authors.initials: M
authors.lastname: Figuera
authors.affiliation: Operations Department, Biometria Clinica CRO, Barcelona, Spain.
authors.forename: Margarida
authors.initials: M
authors.lastname: Garcia-Garcia
authors.affiliation: Medical Department, Ferrer Internacional, Barcelona, Spain.
authors.forename: Liliana
authors.initials: L
authors.lastname: Falkon
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004338:Drug Combinations; D004656:Enalapril / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009568:Nitrendipine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011320:Primary Health Care; D011358:Product Surveillance, Postmarketing; D011446:Prospective Studies
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004338:Drug Combinations; D004656:Enalapril; D009568:Nitrendipine