EFFECTIVENESS OF ENALAPRIL IN COMBINATION WITH LOW-DOSE HYDROCHLOROTHIAZIDE VERSUS ENALAPRIL ALONE FOR MILD-TO-MODERATE SYSTEMIC - HYPERTENSION IN BLACK PATIENTS

The importance of concomitant low-dose hydrochlorothiazide was assesse d in black hypertensive patients treated with enalapril. Left ventricu lar (LV) mass and function, metabolic parameters, 24 hour ambulatory b lood pressure (BP), exercise duration, and systolic BP re sponse were evaluated before and after drug therapy. Enalapril 20 mg (group 1) or enalapril 20 mg plus hydrochlorothiazide 12.5 mg (single tablet; group 2) was given to 38 patients for 9 weeks in a double-blind, placebo-co ntrolled, ran domized study. LV mass measured 61+/-17 ver sus 102+/-23 g/m(2), and 24-hour ambulatory BP measured 120+/-8/75+/-6 versus 155/-12/100+/-6 mm Hg in matched control subjects (n = 40) versus hyperte nsive patients, respectively. No clinically important changes occurred in total cholesterol, serum uric acid or potassium in either group. E nalapril slightly reduced 24-hour ambulatory BP from 154+/-15/100+/-7 mm Hg to 148+/-19/96+/-11 mpn Hg after treatment (9 <0.05 for systolic BP); systolic BP load (70% to 59%, p <0.05), and diastolic BP load (6 7% to 60%, p = NS) decreased. Baseline BP decreased from 157+/-9/101+/ -6 to 132+/-13/86+/-8 mm Hg (p <0.0001); systolic BP load (64% to 29%, p <0.0001), and diastolic BP load (64% to 33%, p <0.0001) decreased i n group 2. Exercise systolic BP was attenuated (p = 0.007, group 2; p = NS, group 1) and duration increased (p = NS) only in group 2. LV mas s decreased 14% (possibly through a direct myocardial effect in group 1 [p <0.05]) and 19% (p = 0.0003) in group 2, with no adverse effect o n cardiac function. It is concluded that enalapril plus low-dose hydro chlorothiazide, rather than enalapril alone, is preferred as first-lin e therapy in black hypertensive patients.