What is the clinical evidence from this study?

Study design: RCT. Population: Uncomplicated essential hypertension (n=32). Intervention: Enalapril vs. Placebo. Primary outcome: Normalization of blood pressure (less than 160/95 mm Hg).

What question did this study set out to answer?

To evaluate the efficacy and tolerability of the angiotensin-converting enzyme inhibitor enalapril in elderly patients with uncomplicated essential hypertension.

April 7, 2009Gerontology

Rationale for ACE Inhibition in the Elderly: Treatment of Arterial Hypertension with Enalapril

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Key result

Enalapril normalized blood pressure in 67% of elderly patients with uncomplicated essential hypertension compared to 35% with placebo over an 8-week period.

Why the study?

Does enalapril reduce blood pressure in elderly patients with uncomplicated essential hypertension?

Key Points

To evaluate the efficacy and tolerability of the angiotensin-converting enzyme inhibitor enalapril in elderly patients with uncomplicated essential hypertension.
Randomized, double-blind, placebo-controlled trial in 32 elderly patients (aged 75–97 years) with uncomplicated essential hypertension.
Patients received enalapril at doses of 20 to 40 mg/day or identical placebo over an 8-week period, with pharmacokinetics assessed in a subset of 10 patients.
Enalapril significantly decreased blood pressure from 190 ± 16 / 102 ± 7 mm Hg to 151 ± 19 / 85 ± 11 mm Hg, achieving normal blood pressure (<160/95 mm Hg) in 67% of patients compared to 35% with placebo (183 ± 16 / 101 ± 9 to 165 ± 21 / 91 ± 13 mm Hg).
Plasma renin activity increased from 1.22 ± 0.08 to 3.66 ± 2.50 ng/ml/h in the enalapril group, aldosterone remained unchanged, and heart rate showed no significant alteration.
Enalapril was generally well tolerated with a mild, significant elevation in creatinine, unchanged serum potassium, and two unrelated deaths.

Study Design

Type

RCT (n=32)

Blinding

Double-blind

Structured PICO

Does enalapril reduce blood pressure in elderly patients with uncomplicated essential hypertension?

Population

32 elderly patients (aged 75-97 years) with uncomplicated essential hypertension, treated over an 8-week period.

Intervention

Enalapril 20 to 40 mg/day over an 8-week period

Comparator

Identical placebo

Outcome

Reduction in systolic and diastolic blood pressure and normalization of blood pressure (<160/95 mm Hg) at 8 weekssurrogate

Main Result

Absolute Event Rate: 67% vs 35%

Enalapril is an effective and well-tolerated antihypertensive medication for elderly patients aged 75-97 years with essential hypertension.

Authors

FFFrançoise ForetteDélégation Paris 5 RHRichard Handfield-JonesCanadian Armed Forces MHM. Henry‐AmarCentre François Baclesse

Discussion

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Implication

Supports enalapril initiation in elderly hypertensives; extends RCT evidence to ages 75-97.

Cite This Study

Forette et al. (2009) conducted an RCT in Uncomplicated essential hypertension (n=32). Enalapril vs. Placebo was evaluated on Normalization of blood pressure (less than 160/95 mm Hg). Enalapril normalized blood pressure in 67% of elderly patients with uncomplicated essential hypertension compared to 35% with placebo over an 8-week period.

synapsesocial.com/papers/6a9fd87b516c2ec66e7c6b39 https://doi.org/10.1159/000212913

Topics

Hypertension management

View Full Paper

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Rationale for ACE Inhibition in the Elderly: Treatment of Arterial Hypertension with Enalapril

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

Topics

Rationale for ACE Inhibition in the Elderly: Treatment of Arterial Hypertension with Enalapril

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

Also Consider

Topics

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