What question did this study set out to answer?

Identify appropriate once-daily combination dosages of ramipril and hydrochlorothiazide for the treatment of mild-to-moderate essential hypertension.

February 1, 1993Journal of Hypertension

Short report: Ramipril and hydrochlorothiazide combination therapy in hypertension: a clinical trial of factorial design

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Why the study?

Does combination therapy with ramipril and hydrochlorothiazide improve blood pressure reduction compared to monotherapy or placebo in patients with mild-to-moderate essential hypertension?

Population

534 randomized patients with mild-to-moderate essential hypertension

Comparison

Combination therapy of ramipril and… vs Ramipril monotherapy, hydrochlorothiazide…

Design

RCT, randomly assigned, double-blind

Follow-up

6 weeks

Authors

ABA. BreitstadtUniversity of North Carolina at Chapel Hill VCVictoria CairnsUniversity of North Carolina at Chapel Hill BBB. BauerUniversity of North Carolina at Chapel Hill

Discussion

Member takes

Implication

Supports ramipril-HCTZ combinations for superior BP control in hypertension; extends RCT evidence for additive efficacy with fewer electrolyte effects.

Key Points

Identify appropriate once-daily combination dosages of ramipril and hydrochlorothiazide for the treatment of mild-to-moderate essential hypertension.
Conducted a 6-week, double-blind, parallel-group 4x3 factorial trial across 21 centers following a 2- to 4-week placebo run-in.
Randomly assigned 534 patients (581 enrolled, 517 completed) with WHO stage I-II essential hypertension and supine diastolic blood pressure of 100-115 mmHg to ramipril (2.5, 5, 10 mg), hydrochlorothiazide (12.5, 25 mg), combinations, or placebo.
Combinations of 5 mg ramipril with 12.5 or 25 mg hydrochlorothiazide and 10 mg ramipril with 12.5 mg hydrochlorothiazide consistently produced significantly greater supine and standing blood pressure reductions than their component monotherapies, with 5 mg ramipril plus 25 mg hydrochlorothiazide yielding the greatest mean reduction.
Combination therapy prevented the substantial decline in serum potassium observed with 25 mg hydrochlorothiazide monotherapy and attenuated hydrochlorothiazide-induced hyperuricemia, with low rates of adverse effects and study withdrawals across all treatment arms.

Structured PICO

Does combination therapy with ramipril and hydrochlorothiazide improve blood pressure reduction compared to monotherapy or placebo in patients with mild-to-moderate essential hypertension?

Population

534 randomized patients with mild-to-moderate essential hypertension (World Health Organization stage I-II; supine diastolic blood pressure 100-115 mmHg in last 2 weeks of run-in)

Intervention

Combination therapy of ramipril (2.5, 5, or 10 mg) and hydrochlorothiazide (12.5 or 25 mg) once a day for 6 weeks

Comparator

Ramipril monotherapy, hydrochlorothiazide monotherapy, or placebo

Outcome

Reduction in supine and standing blood pressure at 6 weekssurrogate

Combination therapy with ramipril and hydrochlorothiazide provides superior blood pressure reduction compared to monotherapy while mitigating thiazide-induced hypokalemia and hyperuricemia.

Cite This Study

Breitstadt et al. (1993) studied this question.

synapsesocial.com/papers/6a71b68ef44fa9f079df7129 https://doi.org/10.1097/00004872-199302000-00015

Topics

Hypertension management

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Implication

Supports ramipril-HCTZ combinations for superior BP control in hypertension; extends RCT evidence for additive efficacy with fewer electrolyte effects.

Short report: Ramipril and hydrochlorothiazide combination therapy in hypertension: a clinical trial of factorial design

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Short report: Ramipril and hydrochlorothiazide combination therapy in hypertension: a clinical trial of factorial design

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Topics

Also Consider