What is the clinical evidence from this study?

Study design: RCT. Population: hypertension (n=174). Intervention: Enalapril vs. Hydrochlorothiazide (HCTZ) 12.5 mg once daily. Primary outcome: Controlled blood pressure (DBP ≤85 mm Hg or SBP ≤140 mm Hg) at 16 weeks.

What question did this study set out to answer?

To compare the antihypertensive efficacy and safety of enalapril and hydrochlorothiazide in elderly patients with essential or isolated systolic hypertension.

April 7, 2009Gerontology

Comparison of Enalapril and Thiazide Diuretics in the Elderly Hypertensive Patient

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Key result

Enalapril and hydrochlorothiazide were equally efficacious in controlling blood pressure in elderly hypertensive patients, achieving control in 79% and 85% of patients respectively at 16 weeks.

Why the study?

Does enalapril compared to hydrochlorothiazide improve blood pressure control in elderly hypertensive patients?

Population

174 elderly hypertensive patients, 68% male, approximately 80% white. 32% had isolated systolic…

Comparison

Enalapril 10 mg once daily. Dose doubled after 4… vs Hydrochlorothiazide 12.5 mg once daily. Dose…

Design

RCT, randomized, double-blind

Follow-up

16 weeks

Authors

HSHarold W. SchnaperNorthwestern University GSGerald H. SteinUniversity of Florida JSJames A. SchoenbergerGeneral / Preventive / Lipids

Discussion

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Implication

Either agent suits initial BP control in elderly hypertensives; confirms short-term equivalence in this RCT.

Key Points

To compare the antihypertensive efficacy and safety of enalapril and hydrochlorothiazide in elderly patients with essential or isolated systolic hypertension.
A double-blind, seven-center, 16-week, controlled study randomized 174 patients aged 65 years or older following a 4-week placebo run-in period.
Patients received once-daily enalapril (10 mg) or hydrochlorothiazide (12.5 mg), with drug doses doubled and stepped add-on therapy initiated at 4-week intervals if blood pressure remained uncontrolled.
Mean blood pressure decreased from 167/94 mm Hg at baseline to 148/85 mm Hg in both groups at week 8 (p ≤ 0.01), reaching 144/83 mm Hg with enalapril and 145/83 mm Hg with hydrochlorothiazide at week 16.
Target blood pressure control (sitting DBP ≤ 85 mm Hg or SBP ≤ 140 mm Hg) was achieved in 79% of the enalapril group and 85% of the hydrochlorothiazide group at 16 weeks.
Overall adverse events occurred in 49% of enalapril patients and 61% of hydrochlorothiazide patients (difference not significant), with laboratory adverse effects reported in 22% versus 32%, respectively.

Study Design

Type

RCT (n=174)

Blinding

Double-blind

Randomization

randomized

Multicenter

Yes

Structured PICO

Does enalapril compared to hydrochlorothiazide improve blood pressure control in elderly hypertensive patients?

Population

174 elderly patients (≥65 years) with hypertension, followed for 16 weeks.

Intervention

Enalapril 10 mg once daily. Dose doubled after 4 weeks if BP not controlled (DBP >85 mm Hg or SBP >140 mm Hg), and the other drug added at successive 4-week intervals if still not controlled, for a total of 16 weeks.

Comparator

Hydrochlorothiazide (HCTZ) 12.5 mg once daily. Dose doubled after 4 weeks if BP not controlled, and the other drug added at successive 4-week intervals if still not controlled, for a total of 16 weeks.

Outcome

Mean blood pressure reduction and proportion of patients with controlled BP (DBP ≤85 mm Hg or SBP ≤140 mm Hg) at 8 and 16 weeks.surrogate

Main Result

Absolute Event Rate: 79% vs 85%

Enalapril and hydrochlorothiazide are equally efficacious for blood pressure reduction in elderly hypertensive patients over 16 weeks.

Cite This Study

Schnaper et al. (2009) conducted an RCT in hypertension (n=174). Enalapril vs. Hydrochlorothiazide (HCTZ) 12.5 mg once daily was evaluated on Controlled blood pressure (DBP ≤85 mm Hg or SBP ≤140 mm Hg) at 16 weeks. Enalapril and hydrochlorothiazide were equally efficacious in controlling blood pressure in elderly hypertensive patients, achieving control in 79% and 85% of patients respectively at 16 weeks.

synapsesocial.com/papers/6a9fd87b516c2ec66e7c6b3a https://doi.org/10.1159/000212916

Topics

Hypertension management

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Comparison of Enalapril and Thiazide Diuretics in the Elderly Hypertensive Patient

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Topics

Comparison of Enalapril and Thiazide Diuretics in the Elderly Hypertensive Patient

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Topics

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