Low-dose combination therapy effective in hypertension

THERAPY

Low-dose combined enaIaprillfelodipine therapy is more effective than higher dose enalapril mono­therapy in patients with hypertension, say researchers from the US-based LEVEL * study group.

In this prospective, multicentre study, 217 patients with hypertension received enaIapril monotherapy 5 mglday for 3 weeks. Subsequently, patients entered the fIrst 6-week treatment phase and were randomised to either enaIaprillO mglday (n = 108) or enalaprill felodipine ['Lexxel'] 5mgl5mg once daily. In the second treatment phase, patients receiving high-dose enalapril monotherapy crossed over to the combina­tion regimen; all patients received enalaprillfelodipine for the last 6 weeks of the 12-week treatment period.

Greater reduction in BP The mean reduction in BP from baseline after the

fIrst 6 weeks of treatment was signifIcantly greater in patients given combination therapy than in patients given high-dose enaIapril monotherapy (-14.21-10.6 vs -9.6/-7.4mm Hg, respectively). The percentage of patients who responded (diastolic BP < 90mm Hg or a reduction of ~ 10mm Hg) was also signifIcantly higher in the combination than the monotherapy group (59 vs 41 % of patients, respectively).

By 12 weeks' treatment, there were no signifIcant differences between groups. The decrease in mean BP from baseline in crossover patients originally random­ised to monotherapy approached that observed in patients receiving 12 weeks of combination therapy (-13.21-10.6 and -15.8/-12.3mm Hg, respectively); a response was seen in 59 and 67% of patients, respectively. * l.ex:xel Vs EniJIopril Elliott WJ, Montoro R, Smith D, LEVEL(LeXllCI vs EnaIapril) Study Group. Comparison of two strategies for intensifying antihypertensive treatment: low-dose combination (ena1april + felodipine ER) venus increased dose of monotherapy (ena1april). American Journal of Hypertension 12: 691-696, Jul 1999 1IOO77a!!7

1173.a32419911198-000131$01 .000 Adl.lntemIltlonal Llm1tecl18911. All right. r ... rved

13

Inpharma- 31 Ju118911 No. 11118