Enalapril achieved a target supine diastolic blood pressure of ≤90 mm Hg in 74% of patients compared to 56% with atenolol at 6 months, though the difference was not statistically significant.
RCT
observer-blind
randomized
Does enalapril compared to atenolol reduce blood pressure in patients with moderate to severe essential hypertension?
Enalapril and atenolol are both effective for moderate to severe hypertension, with enalapril showing a greater reduction in systolic blood pressure when combined with hydrochlorothiazide.
Absolute Event Rate: 74% vs 56%
p-value: p=not statistically significant
Patients with moderate to severe essential hypertension (mean untreated supine blood pressure 190/112 mm Hg) received once daily enalapril 20-40 mg or atenolol 50-100 mg, supplemented if required by hydrochlorothiazide 25-100 mg, in a randomized observer-blind trial. Both regimens produced a highly significant reduction in supine and standing blood pressure. There was no significant difference in the antihypertensive effects of enalapril and atenolol when they were used as monotherapy. After hydrochlorothiazide was added to patients not achieving 'target' blood pressure, the fall in systolic pressure was significantly greater in the enalapril group than in the atenolol group, despite similar dosage of hydrochlorothiazide in the two groups. At the end of 6 months' treatment, a supine diastolic blood pressure of 90 mm Hg or below was achieved in 74% of patients on enalapril plus hydrochlorothiazide and 56% of patients on atenolol plus hydrochlorothiazide. This difference was not statistically significant. A small rise in plasma urea and creatinine was observed in the enalapril group and a small rise of urea only in the atenolol group. These changes were statistically significant but of uncertain clinical importance. This study confirms that once daily enalapril and atenolol, both alone and in combination with hydrochlorothiazide, are effective drugs in the management of moderate to severe hypertension.
Webster et al. (1986) conducted an RCT in moderate to severe essential hypertension. Enalapril vs. Atenolol 50-100 mg once daily was evaluated on Supine diastolic blood pressure of 90 mm Hg or below at 6 months (p=not statistically significant). Enalapril achieved a target supine diastolic blood pressure of ≤90 mm Hg in 74% of patients compared to 56% with atenolol at 6 months, though the difference was not statistically significant.