The combination of hydrochlorothiazide and captopril produced a significant decline in blood pressure in 84% of patients, compared to 64% with hydrochlorothiazide alone and 43% with captopril alone.
RCT (n=255)
Does hydrochlorothiazide, captopril, or their combination improve blood pressure and metabolic parameters in Black and White patients with mild-to-moderate hypertension?
The combination of hydrochlorothiazide and captopril is highly effective for blood pressure control across racial groups and mitigates the adverse metabolic effects seen with hydrochlorothiazide monotherapy.
Mild-to-moderate essential hypertensive patients (255) were assigned to receive hydrochlorothiazide 15 mg three times a day, captopril 25 mg three times a day, or both. A significant decline in blood pressure was seen in 84% of patients taking both agents, while 43% of those taking captopril and 64% of those taking hydrochlorothiazide showed a significant blood pressure response. Among white hypertensives receiving captopril alone, a normalization of blood pressure occurred in 46% and a significant reduction in 8% was observed which was significantly (p less than 0.05) higher than that observed in black subjects where only 31% showed a normalization of their pressure with captopril alone. With hydrochlorothiazide, 53% of blacks and 54% of whites showed normalization of their pressures. With the combination, over 80% of the patients in both racial groups demonstrated a normalization or significant reduction in blood pressure. With hydrochlorothiazide alone, significant (p less than 0.05) decreases in serum potassium, increases in uric acid, blood glucose, and blood cholesterol were seen. With captopril alone, no changes in any of these measurements were observed. When captopril was added to hydrochlorothiazide, a significant attenuation of the diuretic effect on potassium and uric acid was observed, and the significant change in blood sugar and cholesterol seen with the diuretic alone was prevented. These observations suggest that there are heterogeneous responses to hypertensive monotherapy based on race. Furthermore, it suggests that when a single therapeutic agent is not adequate in controlling blood pressure to the desired levels, the addition of either hydrochlorothiazide or captopril should produce a further reduction in blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)
Myron H. Weinberger (Tue,) conducted a rct in Mild-to-moderate essential hypertension (n=255). Combination of hydrochlorothiazide and captopril vs. Hydrochlorothiazide alone or captopril alone was evaluated on Significant decline in blood pressure. The combination of hydrochlorothiazide and captopril produced a significant decline in blood pressure in 84% of patients, compared to 64% with hydrochlorothiazide alone and 43% with captopril alone.