COMBINATION OF ENALAPRIL AND LOW-DOSE THIAZIDE REDUCES NORMOALBUMINURIA IN ESSENTIAL-HYPERTENSION

Objective To examine the effect of the combination of enalapril with a very low dose of hydrochlorothiazide versus atenolol on urinary album in excretion in normoalbuminuric patients with mild to moderate essent ial hypertension. A secondary objective was to compare the effects of the two regimens in patients with different levels of albuminuria. Des ign A 12 weeks, randomized, double-blind, double-dummy, multicenter, c omparative study with two parallel groups. Setting General practices i n Denmark and Finland. Patients The subjects comprised 174 patients wi th mild to moderate essential hypertension, normal serum creatinine an d no proteinuria. Interventions Enalapril/hydrochlorothiazide (20/6 mg ) daily or atenolol (50 mg) daily. Main outcome measures Urinary album in :creatinine ratio and blood pressure. Results At baseline, normoalb uminuria was found in 74 and 85 patients in the enalapril/hydrochlorot hiazide and atenolol groups, respectively. Blood pressure was reduced similarly by both treatments. The ratio of urinary albumin to creatini ne in normoalbuminuric patients was significantly reduced during treat ment with enalapril/hydrochlorothiazide at 20/6 mg (from geometic mean x/divided by antilog SD of 0.53 x/divided by 1.77 to 0.47 x/divided b y 1.58 mg/mmol, P = 0.02) but was unchanged during atenolol treatment (0.55 x/divided by 1.74 and 0.58 x/divided by 1.87 mg/mmol), The diffe rence between the two treatments was statistically significant (P = 0. 03) and was predominantly achieved through a reduction of albuminuria in the upper-normal range during enalapril/hydrochlorothiazide treatme nt. Conclusions Therapy with enalapril/hydrochlorothiazide at 20/6 mg and atenolol at 50 mg once daily reduced blood pressure similarly in p atients with essential hypertension. Suppression of urinary albumin ex cretion within the normoalbuminuric range was observed during treatmen t with enalapril/hydrochlorothiazide at 20/6 mg. (C) 1998 Lippincott W illiams & Wilkins.