Efficacy and tolerability of losartan versus enalapril alone or in combination with hydrochlorothiazide in patients with essential hypertension
Key result
Losartan lowers diastolic BP by ~10 mm Hg, matching enalapril but causing less cough.
Why the study?
Does losartan alone or in combination with hydrochlorothiazide reduce blood pressure compared to enalapril alone or in combination with hydrochlorothiazide in patients with mild-to-moderate essential hypertension?
Population
Patients with mild-to-moderate, uncomplicated essential hypertension and a mean sitting diastolic blood…
Comparison
Losartan 50 mg once daily, with the option to… vs Enalapril 5 mg once daily, with the option to…
Design
RCT, randomized, parallel-group, double-blind
Follow-up
12 weeks
Authors
Discussion
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Implication
Losartan offers a cough-sparing alternative to enalapril; confirms comparable efficacy with better tolerability in essential hypertension.
Study Design
Type
RCT
Blinding
double-blind
Randomization
parallel-group
Multicenter
Yes
Structured PICO
Does losartan alone or in combination with hydrochlorothiazide reduce blood pressure compared to enalapril alone or in combination with hydrochlorothiazide in patients with mild-to-moderate essential hypertension?
P
Population
Patients with mild-to-moderate, uncomplicated essential hypertension followed for a 12-week active treatment phase.
I
Intervention
Losartan 50 mg once daily, with the option to add hydrochlorothiazide 12.5 mg after 8 weeks based on SiDBP.
C
Comparator
Enalapril 5 mg once daily (titratable to 10 mg after 4 weeks), with the option to add hydrochlorothiazide 25 mg after 8 weeks based on SiDBP.
O
Outcome
Change in mean sitting diastolic blood pressure (SiDBP) and mean sitting systolic blood pressure (SiSBP) at 12 weeks.surrogate
Main Result
Absolute Event Rate: 10.3% vs 9.8%
Losartan is as effective as enalapril in reducing blood pressure in patients with essential hypertension, but offers better tolerability with a lower incidence of cough.
Cite This Study
Townsend et al. (1995) conducted an RCT in mild-to-moderate, uncomplicated essential hypertension. Losartan (alone or with hydrochlorothiazide) vs. Enalapril (alone or with hydrochlorothiazide) was evaluated on Mean reduction in sitting diastolic blood pressure (SiDBP) at study end. Losartan reduced mean sitting diastolic blood pressure by 10.3 mm Hg, comparable to a 9.8 mm Hg reduction with enalapril, but was associated with a lower incidence of cough.