Blood pressure-lowering efficacy of amiloride versus enalapril as add-on drugs in
patients with uncontrolled blood pressure receiving hydrochlorothiazide.
Author(s): Guerrero P(1), Fuchs FD, Moreira LM, Martins VM, Bertoluci C, Fuchs SC, Gus M.
Affiliation(s): Author information:
(1)Graduate Study Program in Health Sciences-Cardiology, Universidade Federal do
Rio Grande do Sul (UFRGS), Brazil.
Publication date & source: 2008, Clin Exp Hypertens. , 30(7):553-64
A large proportion of patients with hypertension need a second drug to reach
satisfactory control of blood pressure (BP), but there are few well-designed
controlled trials comparing the efficacy of drugs added as a second option. In a
double-blind randomized clinical trial, 82 patients with uncontrolled BP,
receiving hydrochlorothiazide 25 mg daily, were selected to receive amiloride
2.5-5 mg/day (n = 39) or enalapril 10-20 mg/day (n = 43). Ambulatory blood
pressure monitoring (ABPM) was done before and after 12-weeks of treatment.
Office BP was measured in the 4(th), 8(th), and 12(th) weeks. The doses of
amiloride and enalapril were doubled in the fourth week, and propranolol was
added in the 8th week if office BP was above 140/90 mm Hg. There was a greater BP
reduction in patients treated with enalapril. The ABPM delta values between the
groups were 3.6 +/- 2.2, 3.9 +/- 2.2, and 1.1 +/- 2.7 mmHg for 24-h, daily, and
nightly systolic blood pressure, respectively, favoring enalapril. For diastolic
blood pressure (DBP), the deltas were 1.7 +/- 2.0, 3.2 +/- 1.5, and 1.2 +/- 1.9
mmHg, respectively (p = 0.039 for daily DBP). Office SBP decreased more and
sooner in patients allocated to enalapril (p = 0.003). More patients taking
amiloride required propranolol to control BP (p = 0.035). Potassium increased 0.3
mEq/L on the average in both groups. Cough, albeit predominantly mild, was
reported more frequently by participants treated with enalapril. We conclude that
enalapril is more effective than amiloride to lower BP of patients on
hydrochlorothiazide with uncontrolled BP.
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