title: Differential effects of lercanidipine/enalapril versus amlodipine/enalapril and hydrochlorothiazide/enalapril on target organ damage and sympathetic activation in non-obese essential hypertensive subjects.
abstract: The aim of the present study was to compare the effects of the combination of lercanidipine/enalapril versus amlodipine/enalapril and hydrochlorothiazide/enalapril on blood pressure, target organ damage and sympathetic activation in patients with grade 2 essential hypertension.
  
  
  
  This was a 3 month, randomized, blinded-endpoint study in essential hypertensive patients.
  
  
  
  Office and ambulatory blood pressure, arterial stiffness, urinary albumin to creatinine ratio, renal arterial resistive index, and muscle sympathetic nerve activity were evaluated at baseline, after a 2 week run-in placebo period, at 1 month and at 3 months.
  
  
  
  In total, 56 patients were assigned to lercanidipine/enalapril (n = 19), enalapril/amlodipine (n = 18) and hydrochlorothiazide/enalapril (n = 19). Each pharmacological combination tested was effective in reducing office blood pressure at 1 month and 3 months, and 24 h ambulatory blood pressure at 3 months. Renal arterial resistive index (RI) significantly improved at 1 month and 3 months compared with baseline in all groups. However in the lercanidipine/enalapril and hydrochlorothiazide/enalapril groups, RI was favorably reduced (0.53 ± 0.03 and 0.54 ± 0.04 respectively, p < 0.05) in comparison with the enalapril/amlodipine RI value (0.57 ± 0.03) at 3 months. Moreover, after 3 months of treatment, a significant decrease (by -5.47 bursts/min) (p < 0.05) in muscle sympathetic nerve activity was observed in the lercanidipine/enalapril group (50.79 ± 6.49) compared with baseline (56.26 ± 6.05), while no differences were detected in the amlodipine/enalapril and hydrochlorothiazide/enalapril groups.
  
  
  
  Our study provides evidence of the efficacy of the lercanidipine/enalapril combination in ameliorating hypertension-related target organ damage and in reducing sympathetic overdrive.
authors: a University of Athens, Hippokration Hospital , Athens , Greece.
authors: K
authors: K
authors: Tsioufis
authors: a University of Athens, Hippokration Hospital , Athens , Greece.
authors: Costas
authors: C
authors: Tsioufis
authors: a University of Athens, Hippokration Hospital , Athens , Greece.
authors: Kyriakos
authors: K
authors: Dimitriadis
authors: a University of Athens, Hippokration Hospital , Athens , Greece.
authors: Emmanouil
authors: E
authors: Mantzouranis
authors: a University of Athens, Hippokration Hospital , Athens , Greece.
authors: Ilianna
authors: I
authors: Mani
authors: a University of Athens, Hippokration Hospital , Athens , Greece.
authors: Dimitrios
authors: D
authors: Tousoulis
mesh_terms: D000328:Adult; D017311:Amlodipine / Q000008:administration & dosage*; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D018660:Blood Pressure Monitoring, Ambulatory; D004095:Dihydropyridines / Q000008:administration & dosage*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004656:Enalapril / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000008:administration & dosage* / Q000627:therapeutic use; D006973:Hypertension / Q000188:drug therapy*; D007668:Kidney / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D013564:Sympathetic Nervous System / Q000187:drug effects; D059289:Vascular Stiffness / Q000187:drug effects
chemical_list: D000959:Antihypertensive Agents; D004095:Dihydropyridines; D006852:Hydrochlorothiazide; D017311:Amlodipine; D004656:Enalapril; C060343:lercanidipine
keywords: Enalapril; Hypertension; Lercanidipine; Muscle sympathetic nerve activity; Target organ damage