The effects of mibefradil and enalapril on 24-hour blood pressure control and left ventricular mass in patients with mild to moderate hypertension: Double-blind, randomized trial

In this prospective, double-blind, monocenter drug trial, 48 primary care p atients with mild to moderate essential hypertension were randomized to mib efradil, 50 mg, titrated to 100 mg, or enalapril, 20 mg, titrated to 2 x 20 mg. Ambulatory 24-h blood pressure measurements (ABPM) and echocardiograph y were performed at baseline and after 12 weeks' treatment. Complete data f rom 43 patients were analyzed. Mibefradil (n = 22; titration, 13 patients) reduced mean 24-h ABP from 159 +/- 14/102 +/- 7 mm Hg to 140 +/- 10/89 +/- 7 mm Hg after 12 weeks. Enalapril (n = 21; titration, six patients) reduced baseline ABP from 156 +/- 12/100 +/- 9 mm Hg to 140 +/- 17/89 +/- 10 mm Hg (12 weeks). Trough-to-peak ratios in DBP were 86% for mibefradil and 75% w ith enalapril. Left ventricular mass (LVM) decreased from 199 +/- 65 to 193 +/- 62 g [M-mode modified American Society of Echocardiography (ASE)] and from 184 +/- 65 to 173 +/- 50 g (truncated ellipsoid method) after 12 weeks in response to mibefradil (p > 0.2), and from 212 +/- 50 to 196 +/- 57 g a nd from 182 +/- 39 to 170 +/- 40 g (mean +/- SD, p < 0.02) with enalapril. Mibefradil matched enalapril in 24-h ABP control. Enalapril reduced LVM sig nificantly after 12 weeks (p < 0.02). Mibefradil did not significantly redu ce LVM after 12 weeks.