EFFECTS OF LISINOPRIL OR LISINOPRIL HYDROCHLOROTHIAZIDE COMPARED WITHADJUSTING OF PREVIOUS MEDICATION AND INTENSIFYING NONPHARMACOLOGICAL TREATMENT IN PATIENTS WITH MILD-TO-MODERATE HYPERTENSION/

The objective of this study was to compare the effectiveness of three treatment methods available for treatment of previously medicated pati ents with mild to moderate hypertension. The comparison was made betwe en adjusting or increasing previous medication and switching the previ ous drug treatment to lisinopril (GAS 76547-98-3) or lisinopril hydroc hlorothiazide (GAS 58-93-5) therapy and in both of these treatment gro ups the effect of additional intensified health education was tested. An open, randomised, controlled multi-centre study lasting 36 weeks in volving 189 doctors and 69 nurses was carried out in 155 centres of pr imary health care and occupational health care system in Finland. The study population consisted of 1156 patients, age 30-70 years, (mean DB P 95-115 mmHg in the last three to five measurements during follow-up) . The number of patients achieving target pressure (DBP < 90 mmHg) at the end of the study, defined daily doses (DDD) of antihypertensive dr ugs and side-effects in different treatment groups were regarded as th e main outcome measures of the study. After exclusions and drop-outs t he final analysis was carried out with 900 patients, 419 women (46.6 % ) and 481 men (53.4 %). Patients receiving lisinopril treatment achiev ed target pressure significantly more often (p < 0.001) than those con tinuing their previous or adjusted medication at 36 weeks (59.2 and 55 .5 % vs. 40.3 and 42.7 %). Only a small additional but statistically n on-significant blood pressure lowering effect was achieved with intens ified non-pharmacological treatment at weeks 12 and 24, but this diffe rence had disappeared at week 36. The mean DDDs of different antihyper tensive drugs did not differ between groups except for female patients on previous or adjusted medication not receiving health education, th e mean DDD being significantly (p < 0.05) higher at weeks 24 and 36 in this group. The profile of adverse effects at the end of the study de arly favoured patients on lisinopril treatment except for cough which was reported in 18 % of patients vs 10 % in the control groups. 81 pat ients on lisinopril treatment were withdrawn from the study because of cough. The results shelved that hypertensive patients with poor treat ment control benefit from all three approaches. A greater proportion o f patients on lisinopril treatment achieved target pressure and also e xperienced fewer side effects than those continuing on adjusted previo us medication. Intensified personal health education given once a mont h during six months had only a small additional beneficial effect on r eaching the target pressure and this effect was lost in three months a fter the health education period.