THE EFFICACY AND TOLERABILITY OF ENALAPRIL IN A FORMULATION WITH A VERY-LOW DOSE OF HYDROCHLOROTHIAZIDE IN HYPERTENSIVE PATIENTS RESISTANT TO ENALAPRIL MONOTHERAPY

The antihypertensive efficacy and tolerability of formulations of enal april and low (12.5 mg) and very low (6 mg) doses of hydrochlorothiazi de (HCTZ) were compared with enalapril and placebo. Four hundred and t wo patients with mild to moderate essential hypertension were treated with 20 mg enalapril for 8 weeks. Patients (n = 296) with persistent s upine diastolic blood pressure >95 mm Hg after enalapril monotherapy w ere randomized to receive enalapril/placebo (group I), 6 mg enalapril/ HCTZ (group II), or 12.5 mg enalapril/HCTZ (group III) for another 8 w eeks in a double-blind design. The mean reductions in blood pressure w ere significantly larger in groups II and III compared to group I, 7.3 (95% CI, -9.0;-6.2), 7.7 (-9.2;-6.3), and 4.1 (-5.9;-2.9) mm Hg, resp ectively P <.01 for groups II and III compared to group I). No differe nce in side effects was observed between the three groups. A very low dose of 6 mg HCTZ acts synergistically when given together with enalap ril, but is devoid of adverse metabolic effects.