THE TREATMENT OF SEVERE HYPERTENSION WITH TRANDOLAPRIL, VERAPAMIL, AND HYDROCHLOROTHIAZIDE

A multiple drug regimen consisting of trandolapril, verapamil and hydr ochlorothiazide (HCTZ) were sequentially added in an open-label evalua tion of patients with severe hypertension. Ninety patients (58 white a nd 32 black patients) were titrated on one or more drugs and followed for a 19-week maintenance period, Statistically significant (P = 0.001 ) mean (+/- s.d.) decreases in supine diastolic blood pressure (DBP) w ere 9.0 (+/- 9.3) mm Hg for trandolapril, 13.9 (+/-11.0) mm Hg for the trandolapril + verapamil (TV) combination, and 19.0 (+/-12.3) mm Hg w hen hydrochlorothiazide was added to the combination. The decrease in BP observed on TV combination therapy plus HCTZ was significantly (P = 0.001) greater than the decrease observed for the TV combination, whi ch was significantly (P = 0.001) greater than the decrease observed fo r trandolapril monotherapy. Clinical responder rates were 44.8%, 56% a nd 77.7% for trandolapril monotherapy, trandolapril + verapamil combin ation therapy and triple therapy, respectively. Black and white patien ts had similar response rates, but black patients appeared to benefit more from the addition of HCTZ; 20% of black patients achieved a post- treatment supine DBP <90 mm Hg compared to 12.8% of white patients. Th is study demonstrates that the addition of verapamil to trandolapril h as an additive effect on BP that is maintained throughout the day.