Evaluation of amlodipine, lisinopril, and a combination in the treatment of essential hypertension
M U R Naidu, P R Usha, T Ramesh Kumar Rao, J C Shobha
Department of
Clinical Pharmacology and Therapeutics, Nizam's Institute of Medical
Sciences, Panjagutta, Hyderabad, India
Correspondence to: Professor M U R Naidu, Department of Clinical Pharmacology and Therapeutics, Nizam's Institute of Medical Sciences, Hyderabad 500 082, India (e-mail: murnaidu{at}hotmail.com)
Submitted 13 August
1999;
Accepted 18 August 1999
Angiotensin converting enzyme (ACE) inhibitors and
dihydropyridine calcium antagonists are well established and widely
used as monotherapy in patients with mild to moderate essential
hypertension. Earlier studies combining short acting drugs from these
classes require multiple dosing and were associated with poor
compliance. Availability of longer acting compounds allows once daily
administration to avoid the inconvenience of a multiple daily dose. It
was decided to perform a randomised double blind, crossover study with
the long acting calcium channel blocker amlodipine and the long acting ACE inhibitor lisinopril, given either alone or in combination in
essential hypertension. Twenty four patients with diastolic blood
pressure (DBP) between 95 and 104 mm Hg received amlodipine 2.5 mg and
5 mg, lisinopril 5 mg and 10 mg, and their combination as per a prior
randomisation schedule. Supine and standing blood pressure and heart
rate were recorded at weekly intervals. Higher doses of both the drugs
individually or in combination were used if the target supine DBP below
90 mm Hg was not achieved. There was a significant additional blood
pressure lowering effect with the combination when compared either with
amlodipine or lisinopril alone. Five mg amlodipine and 10 mg lisinopril
monotherapy achieved the target blood pressure in 71% and 72%
patients respectively. The combination of 2.5 mg amlodipine with 5 mg
lisinopril produced a much more significant lowering of blood pressure
in a higher percentage of patients than that with an individual low dose.
Keywords: amlodipine; lisinopril; hypertension; combination therapy
© 2000 by The Fellowship of Postgraduate Medicine
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