Effects of eprosartan versus enalapril in hypertensive patients on the renin-angiotensin-aldosterone system and safety parameters: Results from a 26-week, double-blind, multicentre study

A double-blind comparator study was performed in 528 hypertensive patients [baseline sitting diastolic blood pressure (SitDBP) 95-114 mmHg]. The prima ry objective was to compare the incidence of drug-related cough in patients treated with enalapril and eprosartan. The secondary objective was to comp are antihypertensive efficacy between treatments. This paper reports the ef fects seen on the safety profile, plasma renin activity, aldosterone and an giotensin II (A-II) in each treatment group. Eprosartan was titrated from 2 00 mg b.i.d. to 300 mg b.i.d. and enalapril from 5 mg o.d. to 20 mg o.d. ov er 12 weeks. Hydrochlorothiazide (HCTZ) 12.5-25 mg o.d. could be added wher e required to the treatment for the final six weeks of the titration phase if SitDBP greater than or equal to 90 mmHg. Patients received the maximum t itrated dosage during the maintenance phase. In the study overall, similar mean changes in blood pressure from baseline were evident with each treatme nt. Measurement of mean plasma neurohormone levels showed significant incre ases in renin activity in both groups and statistically significant A-II el evations in the eprosartan group (p < 0.05). Neither eprosartan nor enalapr il significantly altered serum lipid profiles or electrolyte levels. Most a dverse experiences reported throughout the study were mild or moderate in b oth treatment groups. Fewer patients receiving eprosartan (4.9%) than enala pril (9.1 %) discontinued treatment because of adverse experiences. In conclusion, the results of this study show that eprosartan is well toler ated. Both eprosartan and enalapril significantly increased plasma renin ac tivity while plasma A-II was elevated in the eprosartan group.