ADDITIVE EFFECTS OF VERAPAMIL AND ENALAPRIL IN THE TREATMENT OF MILD-TO-MODERATE HYPERTENSION

A factorial design was applied in this multicenter, double-blind, plac ebo-controlled trial of the calcium-channel blocker verapamil and the ACE inhibitor enalapril to assess the hypotensive effects of the combi nation compared with monotherapy, to evaluate safety, and to determine the effects on quality of life (QOL) of both drugs, alone and in comb ination. The study consisted of a 3 x 2 factorial design wherein 186 m en and women with a sitting diastolic blood pressure (BP) of between 9 5 mm Hg and 114 mm Hg, after a 4-week placebo washout, were randomized to one of six treatment groups for 4 weeks of active treatment. Monot herapy with both 240 mg verapamil and 10 mg enalapril reduced systolic and diastolic BP to a similar extent and significantly more than plac ebo. The 240 mg verapamil + 10 mg enalapril combination was additive f or both systolic and diastolic blood pressure; 120 mg verapamil + 10 m g enalapril was additive for systolic BP only. The total number of adv erse events reported was similar for all six treatment groups. QOL sco res were unchanged from baseline and not different between treatment g roups. The combination of 240 mg verapamil and 10 mg enalapril was sig nificantly more effective at reducing BP than either drug alone; this additivity of effect was not linked to a higher rate of adverse experi ences or to a deterioration in QOL. Thus, combination therapy at lower doses may offer an alternative treatment option to higher dose monoth erapy.