Enalapril versus hydrochlorothiazide: DISCUSSION(2) / Symbicort Dosage

21 Sep
2012

Enalapril versus hydrochlorothiazide: DISCUSSION(2)

It is also possible that the doses of enal april used in this study may not be equivalent in potency to the doses of hctz/ amiloride used in this study. For some patients, because blood pressure levels obt ained were trough levels, a twice daily administration of enalapril may have been more effective. Most likely, doses were not comparable and enalapril was used at a suboptimal dose. Nevertheless, even at the doses compared in this study, both treatments were similar in outcome for reduction of all types of diastolic blood pressure. When doses closer to those used in clinical practice today were compared (enalapril 5 or 10 mg versus hctz/ amiloride 25/2.5 mg), statistically significant mean differences in diastolic blood pressure in favour of enalapril were seen. Furthermore, a greater percentage of patients who received enalapril were controlled versus those who received hctz/ amiloride at these dos age lev els.

Ad verse experiences were minimal and both buy diabetes drugs were well tolerated. Four cases of hypokalemia occurred with hctz/ amiloride. Although doses of hctz in excess of 25 mg have been associated with an increased likelihood of adverse metabolic effects and are no longer recommended in clinical practice, the reports of hypokalemia in our study occurred at the lower dosages (two cases at 25/ 2.5 mg and two cases at 50/ 5 mg). This demonttrates that a combined potassium-sparing diuretic and hctz minimizes but cannot completely eliminate the hypokalemic side effects of thiazide diuretics. There were no reports of hyperlipidemia. A slight increase in mean serum creatinine con cen tration was observed in the enalapril group. This change was not clinically significant and re mained within clini cally nor mal range lim its. Fa -vourable renal responses have been documented with AcE inhibitors, such as enalapril, including reduction of renal vas-cu lar resistance, en hancement of renal blood flow, en hance-ment of glomerular filtration rate and decreased urinary protein excretion. Small increases in mean serum creatinine concentration were seen within both groups but this was statistic ally significant only for pat ients treated with hctz/ amiloride. Most likely, this greater effect with hctz/ amiloride reflected a constriction of the plasma volume consistent with the intake of a diuretic.

At present, both of these classes of antihypertensive agents have been recommended for the treatment of mild to moderate es sen tial hy per ten sion. Diu ret ics have been shown to be useful in all age groups but particularly in elderly hypertensive patients, where they have been shown to reduce the incidence of stroke and heart disease. However, diuretics are not without some adverse metabolic effects that may offset the primary benefits achieved by treatment. Combination potassium-sparing diuretics, such as hctz/ amiloride, should be particularly useful in the elderly because the possibility of hypokalemia and its adverse consequences are diminished. ace inhibitors have been used widely and successfully in the management of all forms of hypertension and, notably, with success in the elderly. Find best deals online – Symbicort Dosage can be available every time you visit.

In this study, both enatapril and hctz/ amiloride were demonstrated to be equally effective in controlting mild to moderate essential hypertension. The tolerability and safety profiles of both agents were also similar except for four cases of hypokalemia that occurred in the hctz/ amiloride group.

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