1. Home>
2. Specialties>
3. General Medicine>
4. Summary and Comment

ACE INHIBITORS PLUS LOW-DOSE THIAZIDES FOR HYPERTENSION.

Angiotensin-converting-enzyme inhibitors and diuretics have different antihypertensive actions. Combination therapy is attractive because ACE inhibitors counterbalance the diuretic-induced activation of the renin-angiotensin system. However, conventional doses of diuretics have several adverse metabolic effects. This multicenter study tested whether low-dose combination therapy is effective and safe in patients with mild to moderate hypertension.

Researchers randomized 505 patients with diastolic pressures from 100 to 114 mm Hg to one of five 12-week regimens: lisinopril monotherapy (10 mg/day), hydrochlorothiazide monotherapy (either 12.5 or 25 mg/day), or combination therapy (lisinopril plus either of the two thiazide doses).

The two combination regimens reduced diastolic pressure the most (14 to 18 mm Hg) and had equal efficacy. However, the combined regimen using the higher thiazide dose was associated with increased serum glucose levels (without changes in potassium, creatinine, or uric acid). Lisinopril monotherapy was least effective in black patients, but combination therapy was as effective in blacks as in other patients. Elderly patients also responded well to combination therapy.

Comment: This study adds to strong evidence indicating that ACE inhibitors should be used with thiazides. It also adds evidence suggesting that very low doses of thiazides are effective and do not have adverse metabolic consequences. However, the conclusions would have been stronger had lipid levels also been measured and reported.

— AL Komaroff

Published in Journal Watch General Medicine May 3, 1994

Citation(s):

Chrysant SG et al. Antihypertensive effectiveness of low-dose lisinopril- hydrochlorothiazide combination: a large multicenter study. Arch Intern Med 1994 Apr 11 154 737-743.

• Medline abstract (Free)