December 5, 2008The Nephron journals/Nephron journals
Cross-Over Factorial Studies with Antihypertensive Drugs
Key result
Combining enalapril with hydrochlorothiazide produced additive hypotensive effects, whereas combining enalapril with atenolol yielded little additional hypotensive effect.
Why the study?
Do combinations of antihypertensive drugs have additive hypotensive effects in patients with uncomplicated mild to moderate hypertension?
Population
Patients with uncomplicated mild to moderate hypertension
Comparison
Antihypertensive drug combinations vs Individual antihypertensive drugs
Design
Review
Authors
Discussion
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Implication
Supports additive BP effects with ACEI-diuretic but not ACEI-beta blocker combinations; leaves open definitive recommendations pending higher-level evidence.
Structured PICO
Do combinations of antihypertensive drugs have additive hypotensive effects in patients with uncomplicated mild to moderate hypertension?
P
Population
Patients with uncomplicated mild to moderate hypertension
I
Intervention
Antihypertensive drug combinations (beta-blockers and diuretics; enalapril 20 mg daily and hydrochlorothiazide 50 mg daily; enalapril and atenolol 50 mg daily)
C
Comparator
Individual antihypertensive drugs
O
Outcome
Hypotensive and biochemical effectssurrogate
The combination of an ACE inhibitor and a beta-blocker provides little additional blood pressure lowering compared to either agent alone, whereas ACE inhibitors and diuretics are additive.
Limitations
- The mechanism of the attenuated hypotensive effect when combining enalapril with atenolol is unclear.
Cite This Study
Wing et al. (2008) conducted a review in Uncomplicated mild to moderate hypertension. Antihypertensive drug combinations (enalapril, hydrochlorothiazide, atenolol) vs. Individual antihypertensive agents was evaluated on Hypotensive and biochemical effects. Combining enalapril with hydrochlorothiazide produced additive hypotensive effects, whereas combining enalapril with atenolol yielded little additional hypotensive effect.