Evaluation of the efficacy and safety of enalapril plus hydrochlorothiazide plus
methyldopa vs standard triple therapy in the treatment of moderate to severe
hypertension: results from a multicentre study.
Author(s): Leonetti G, Cuspidi C, Sampieri L, Ambrosioni E, Malini PL, Pessina A, Semplicini
A, Cinotti G, Morabito S, Rappelli A, et al.
Affiliation(s): Institute of Clinica Medica, University of Milan, Italy.
Publication date & source: 1990, J Hum Hypertens. , 4(1):5-11
We report the results of a randomized, double-blind, parallel group multicentre
study in 120 patients with moderate to severe hypertension, comparing two
different types of antihypertensive treatment: a) the standard 'triple therapy'
with hydrochlorothiazide, propranolol and hydralazine, and b) the combination of
an ACE inhibitor, enalapril with hydrochlorothiazide (HCTZ) and methyldopa. The
two regimens caused similar degrees of blood pressure reductions. The only
significant difference between the two groups was heart rate due to the
bradycardiac effect of propranolol in the group treated with the standard 'triple
therapy'. Only 3.4% of patients receiving the regimen of enalapril, HCTZ and
methyldopa were withdrawn from the study for adverse reactions, against 10% of
patients on HCTZ, propranolol and hydralazine. Four cases of hypokalaemia in the
enalapril group and 19 in the propranolol group were reported: so enalapril
seemed to ameliorate the hypokalaemic effect of HCTZ. The overall analysis of the
study results shows that the treatment based on enalapril, HCTZ and methyldopa is
as efficient and better tolerated than the established regimen of HCTZ,
propranolol and hydralazine.
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