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Angiotensine-Converting Enzyme Inhibitor Plus Calcium Channel Blocker Combination More Efficient Than Calcium Channel Blocker Alone in Patients With Stage 2 Hypertension

An initial treatment regimen including a combination of angiotensin-converting enzyme inhibitor and calcium channel blocker at fixed doses provides significantly greater efficacy compared to a high-dose calcium channel blocker monotherapy in patients with stage 2 hypertension, write researchers.

Recently, the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure released its Seventh Report (JNC 7 report) recommending that patients whose blood pressure (BP) is higher than 20/10 mm Hg above goal be treated initially with combination antihypertensive therapy.

"The primary objective of the study was to compare the percentage of patients achieving a reduction in systolic BP of ¡Ý 25 mmHg, if baseline systolic BP was < 180 mm Hg, or ¡Ý 32 mm Hg, if baseline systolic BP was ¡Ý 180 mm Hg, during 12 weeks of a daily treatment regimen with amlodipine besylate/benazepril HCl, versus amlodipine besylate monotherapy," explains Kenneth A. Jamerson, MD, University of Michigan Medical Center, Ann Arbor, and colleagues.

Amlodipine besylate/benazepril hydrochloride (HCl) is a fixed-dose combination antihypertensive containing a dihydropiridine calcium channel blocker (CCB) and an angiotensin-converting enzyme (ACE) inhibitor.

The multicentre, double-blind, parallel-group study randomised 364 patients with stage 2 hypertension to fixed-dose combination therapy with amlodipine/benazepril HCl, 5/20 mg per day titrated to 10/20 mg per day, or to amlodipine besylate monotherapy, 5 mg per day titrated to 10 mg per day.

Significantly more patients who were randomised to amlodipine besylate/benazepril HCl fixed-dose combination therapy attained the primary objective of the study compared with patients randomised to amlodipine besylate monotherapy (P < .0001).

The proportion of patients who attained reduction in diastolic BP ¡Ý 15 mm Hg, if baseline diastolic BP < 110 mm Hg, or ¡Ý 20 mm Hg, if baseline diastolic BP was ¡Ý 110 mm Hg, was significantly greater for patients randomised to fixed-dose combination therapy compared with patients randomised to monotherapy (P = .0003).

Significantly more patients in the combination group achieved a BP goal of < 140/90 mm Hg during the treatment period compared with patients in the monotherapy group (P = .0007).

The incidence of peripheral oedema was significantly higher in the monotherapy group compared to the combination group (P = .0102). The incidence of adverse events was slightly higher in the monotherapy group than in the combination group without reaching statistical significance.

Fixed-dose angiotensin-converting enzyme inhibitor/calcium channel blocker combination therapy is an effective and well tolerated therapeutic option for the initial treatment of patients with the highest systolic blood pressure at baseline (¡Ý 180 mm Hg), note the researchers.

"This study supports the JNC 7 recommendation for initial use of combination therapy in patients with stage 2 hypertension and further demonstrates that fixed-dose ACE inhibitor/CCB combination therapy is an effective and well tolerated therapeutic option for initial treatment of these high-risk patients," they conclude.

Am J Hypertens 2004 Jun;17:6:495-501 "Initial angiotensin-converting enzyme inhibitor/calcium channel blocker combination therapy achieves superior blood pressure control compared with calcium channel blocker monotherapy in patients with stage 2 hypertension"

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