Hver er ákjósanleg samsetning enalapríls og hýdróklórtíasíðs við háþrýstingi?

Abstract

Studies are lacking regarding the optimal combination of angiotensin converting enzyme inhibitors (ACE-blockers) and thiazides in mild to moderate hypertension. Therefore a randomized double-blind cross-over study was performed on 24 hypertensive patients who were randomized to group A, 13 patients, and group B, 11 patients, all except two were males. Group A recieved enalapril (E) 10 mg + hydrochlorothiazides (H) 12.5 mg (regime 1), E 10 mg + H 25 mg (regime 2), E 20 mg + H 12.5 mg (regime 3) and E 20 mg + H 25 mg (regime 4). Each regime lasted four weeks. For group B regimes 1 and 2 and 3 and 4 were switched. The patients were interviewed with regard to 29 potential side-effects, each classified minor or major and several biochemical variables were measured. A significant fall of blood pressure was found at regime 1 in comparsion with control values: supine (mean) 163/104 vs 137/85 mm Hg and standing 156-105 vs 135/90 mm Hg. However, no significant blood pressure fall was produced by further increasing the dose. A non-significant tendency to more numerous and more severe side-effects was observed at the higher doses of H. In addition, higher H doses were associated with significant increases in serum creatinine, uric acid and glucose. Little is gained by increasing the dose of enalapril and hydrochlorothiazide above 10 mg and 12.5 mg. Higher doses are associated with elevated cost, metabolic disturbances and probably more numerous side-effects.

Rannsókn þessi var gerð til að leita að heppilegustu samsetningu angiotensin ummyndunar ensímblokka (enalapríls, E) og þvagræsilyfja (hýdróklórtíasíðs, H) við vægum til meðalsvæsnum háþrýstingi. Tuttugu og fjórir sjúklingar luku rannsókninni sem skiptist í fjórar meðferðarlotur að loknu fjögurra vikna tímabili án lyfja: Meðferð 1: E 10 mg + H 12,5 mg; meðferð 2: E 10 mg + H 25 mg meðferð 3: E 20 mg + H 12,5 mg; meðferð 4: E 20 mg + H 25 mg. Spurt var kerfisbundið um 31 hugsanlega hjáverkun og mælingar gerðar á 12 breytum í blóði. Blóðþrýstingur bæði í liggjandi og standandi stöðu var lægri á meðferð 1 en fyrir meðferð, en engin frekari marktæk breyting varð á meðferð 2, 3 og 4. Tíðni hjáverkana var hæst á meðferð 4, en næsthæst á meðferð 2. Í báðum tilvikum var skammtur H 25 mg. Lítill ávinningur reyndist af því að auka skammta umfram E 10 mg + H 12,5 mg.