EFFICACY OF RAMIPRIL VERSUS ENALAPRIL IN PATIENTS WITH MILD-TO-MODERATE ESSENTIAL-HYPERTENSION

This double-blind, randomised, cross-over study investigated the antih ypertensive efficacy of ramipril and enalapril was completed by 30 pat ients with mild-to-moderate essential hypertension. After a four-week placebo run-in phase, the patients received either 2.5mg ramipril or 1 0mg enalapril once daily for four weeks. The dosages were increased to 5mg ramipril and 20mg enalapril for a further four weeks. After a pla cebo washout phase of four weeks, the patients were crossed over to th e alternative treatment. The decrease in average 24-hour ambulatory di astolic blood pressure from week 0 to week 8 was 1.6mmHg greater with ramipril than enalapril (90% confidence interval 0.6-2.7mmHg). The cor responding reduction in for systolic blood pressure was also greater w ith ramipril than enalapril by 2.4mmHg (90% confidence interval: 0.5-4 .2mmHg). For the difference in the drop of 24-hour ambulatory diastoli c blood pressure between ramipril and enalapril the fewer level of the 90% confidence interval (CI) is above the clinically relevant differe nce of -3mmHg. This is an indication that ramipril (2.5 and 5mg dose) is at least as effective as enalapril (10 and 20mg dose) in decreasing blood pressure in patients with mild-to-moderate essential hypertensi on. The duration of adequate antihypertensive effect was relatively lo ng for both ramipril and enalapril; however, ramipril tended to have a more prolonged antihypertensive effect. Ramipril had a higher diastol ic and systolic trough/peak ratio than enalapril, resulting in a more uniform antihypertensive effect over the 24-hour treatment period. Bot h ramipril and enalapril were well tolerated and the two treatment gro ups had similar safety profiles.