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Antihypertensive Effect of Low‐Dose Hydrochlorothiazide Alone or in Combination with Quinapril in Black Patients with Mild to Moderate Hypertension
Author(s) -
Radevski I. V.,
Valtchanova Z. P.,
Candy G. P.,
Hlatswayo M. N.,
Sareli P.
Publication year - 2000
Publication title -
the journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.92
H-Index - 116
eISSN - 1552-4604
pISSN - 0091-2700
DOI - 10.1177/00912700022009468
Subject(s) - quinapril , hydrochlorothiazide , medicine , diuretic , pharmacology , cardiology , blood pressure , ace inhibitor , angiotensin converting enzyme
In this study, using 24‐hour ambulatory blood pressure (BP) monitoring, the authors assessed the potential for BP control using hydrochlorothiazide (HCTZ, 12.5 mg daily), given as a monotherapy over 12 months to 49 black South African patients with mild to moderate hypertension (mean day diastolic blood pressure [DBP] ≥ 90 and < 115 mmHg). Uncontrolled patients received fixed combination of quinapril/HCTZ 10/12.5,20/12.5, and 20/25 mg, with dose titration at 3 monthly intervals if BP control was not achieved (day DBP < 90 mmHg). Overall, profound and sustained BP reduction was observed at the end of the study. The 24‐hour BP decreased from 151 ± 14/98 ± 7 to 136 ± 15/87 ± 9mmHg (p < 0.0001 at end of study vs. baseline); the mean day BP decreased from 155 ± 14/104 ± 7 to 140 ± 15/91 ± 10 mmHg (p < 0.0001 at end of study vs. baseline). The overall control (mean day DBP < 90 mmHg) and response (decrease in day DBP ≥ 10 mmHg) rates were 49% and 61%, respectively. At the end of the study, only 2 patients (4%) remained on treatment with HCTZ. Out of the initial 12 patients controlled on HCTZ at 3 months (12/49, 24%), 5 patients remained controlled at 6 months and only 1 patient at 12 months. In contrast, quinapril/HCTZ combinations maintained their antihypertensive effect up to 9 months, with a significant number of patients (22/49, 45%) requiring the highest dose of the combination (20/25 mg daily). In conclusion, low‐dose HCTZ should not be recommended as monotherapy in black patients with mild to moderate hypertension due to the fact that the BP‐lowering effect is attenuated already at 6 months of treatment, with most patients requiring the addition of the ACE inhibitor.