COMPARISON OF CAPTOPRIL-THIAZIDE AND ENALAPRIL-THIAZIDE COMBINATIONS IN THE MANAGEMENT OF MILD-TO-MODERATE BLACK HYPERTENSIVE PATIENTS - HOW IMPORTANT IS DIURETIC DOSE AND DURATION OF ACTION OF THE ACE-INHIBITOR

A double-blind, randomized, parallel-group study was performed to comp are the efficacy and tolerability of captopril-thiazide and enalapril- thiazide combinations. After a 3-week placebo run-in period, 47 Black patients with mild to moderate essential hypertension (mean 24-hour di astolic blood pressure (BP) > 90 mmHg and < 115 mmHg) were randomized to receive 1 of 2 combination tablets: captopril 50 mg plus hydrochlor othiazide 25 mg (CAP, n = 24) or enalapril 20 mg plus hydrochlorothiaz ide 12.5 mg (COR, n = 23) once daily. After 12 weeks of active treatme nt the mean 24-hour ambulatory BP was reduced from 152 +/- 11/99 +/- 6 to 133 +/- 13/86 +/- 7 mmHg (p < 0.005) in the CAP group and 157 +/- 15/100 +/- 6 to 141 +/- 18/90 +/- 12 in the COR group (p < 0.005). Tar get BP (24-hour diastolic BP < 90 mmHg) was achieved in 75% (18/24) of patients on CAP and 48% (11/23) on COR (p = n.s.). 24-hour BP load fe ll significantly with both CAP (from 69% to 34%, p < 0.001) and COR (f rom 67% to 37%, p < 0.001). Left ventricular mass index decreased by 7 % with CAP and 11% with COR. Cardiac index and fractional shortening r emained essentially unchanged in both groups. Both treatments were wel l tolerated and overall incidence of side effects was very low. It is concluded that both CAP and COR are effective, safe first-line antihyp ertensive choices in Black patients with mild to moderate hypertension with the former showing a trend towards greater efficacy than the lat ter.