Enalapril versus hydrochlorothiazide: RESULTS(2) / Symbicort for Asthma

19 Sep

To examine efficacy at doses more comparable with those used in clinical practice today, results at week 12 for 90 patients treated with enalapril 5 and 10 mg (average dose 7 mg) were compared with those at week 8 for 92 patients treated with hctz/ amiloride 25/ 2.5 mg. At these more commonly used dosages, no significant difference in systolic blood pressure was demonstrated; however, a statistically significant difference was evident for diastolic blood pressure taken in the supine position (P=0.001) and in both standing positions at 1 min (P=0.03) and 3 mins (P=0.02) in favour of enalapril (Table 3). Moreover, at these more commonly used dosages, a greater proportion of patients receiving enalapril was controlled than those who received hctz/ amiloride (74.4% versus 55.4%) (Table 4). Shop with best online pharmacy and find Symbicort for Asthma getting the most out of it.

TABLE3 Mean change from baseline for blood pressure

ResultsEnalapril 5 n and 10 mg*HCTZ/amiloride n 25/2.5 mg+ P value
at week12versus8
Supine BP (mmHg)
Systolic90 -14.54±13.4092-12.47±13.990.31
Diastolic90 -13.78±8.2092-9.76±8.420.001
Standing BP 1 min (mmHg)
Systolic90 -13.52±15.2890-13.60±13.140.97
Diastolic90 -12.20±8.8390-9.43±8.090.03
Standing BP 3 min (mmHg)
Systolic90 -13.84±15.3891-14.48±12.860.76
Diastolic90 -11.88±9.1391-8.88±7.860.02

*Average dose 7.0 mg/day; ^Average dose 25/2.5 mg/day. BP Blood pressure; HCTZ Hydrochlorothiazide

TABLE4 Controlled patients

WeekDose/dayAveragedoseControlled:n (%)
Enalapril125 and 10 mg7 mg67 (74.4%)
HCTZ/amiloride825/2.5 mg25/2.5 mg51 (55.4%)

HCTZ Hydrochlorothiazide.

The extent of laboratory adverse effects and changes were minimal in the enalapril group. Alkaline phosphatase increased from a mean of 83.6±40.5 U/ L to 87.4+41.1 U/ L, which was statistically significant but of no apparent clinical importance. No clinically significant changes were observed in any hematological parameter. Similarly, serum creatinine concentration increased slightly from a mean of 87.0±15.4 |imol/ L to 89.1±16.4 |imol/ L; howrver, this mean inrrease remained within nor mal lim its. Mean se rum po tas sium con cen tra tion was noted to be slightly increased (0.09 mmol/ L) which also was not sta tis tically sig nificant. The remain der of labo ra tory parameters were unremarkable in their mean changes during the study.

A statistically significant decrease in mean serum potassium concentration was observed in the hctz/ amiloride group from 4.25±0.35 mmol/ L at baseline to 4.08±0.44 mmol/ L at exit. Four cases of mild hypokalemia (potassium 3.5 mmol/ L or less) were observed. Mean serum creatinine concentration increased slightly from 87.9±18.1 |imol/ L to 90.8±19.8 |imol/ L and this was found to be statistically significant. This parameter was well within normal limits and clinically not important. Mean fasting blood sugar concentration also increased significantly from 5.64±1.17 mmol/L to 5.95±1.55 mmol/ L. All other biochemical laboratory parameters remained relatively unchanged throughout the study. Mean serum uric acid con cen tra tion in creased sig nificantly during the study period and only one patient receiving hctz/ amiloride reported hyperuricemia.