Atenolol, Enalapril and Hydrochlorothiazide in Hypertension Comments on a recent comparative trial

A recent study [/npharma 535: 7, 3 May 1986] comparing the antihypertensive efficacy of enalapril, atenolol and hydrochlorothiazide did not state how double-blindness was maintained or in how many patients the dose of the different drugs was doubled. Further, statistical tests of significance were not performed between drugs to compare their incidence of side effects or their antihypertensive efficacy and, thus. one cannot accurately conclude that ·enalapril is a viable alternative to established first-line therapies in mild to moderate hypertension·. This is especially so as the dose of hydrochlorothiazide used provided submaximal therapeutic effect and the follow-up time was too short and the sample number too small. Gotzche PC Lancet 2 38·39.5 Jul 1986

Dose doubling occurred in 55% of enalapril, and 44 and 57% of atenolol and hydrochlorothiazide recipients, respectively. Double-blindness was maintained at this time, and throughout the study, by excluding information about patient medication from the physician (although J-blocker effects may be noted this is a hazard with all studies involving these agents). Statistical tests were performed between drugs to compare incidence of side effects and ani hypertensive efficacy. Further, even though the hydrochlorothiazide dose produced a sub maximal effect it did achieve goal BP.

The trial's conclusion ' ••• does not reflect any view on long-term effects on life-expectancy but was based on and limited to, information available on enalapril'. Helgeland 4 Hage1und CH Stfflmmen R rTett, S Lancet 2 39·40 5 Jul 1986

0156·2703/86/0802-0005/0$01.00/0 @ ADiS Press INPHARMA'" 2 Aug 1986 5