Safety and effectiveness of combination treatments for hypertension

This study examined the safety and effectiveness of a lercanidipine (Zanidip)/enalapril (Vasotec) combination in patients with hypertension. The authors concluded that a combination of these drugs given at 20mg each per day is the most effective dosage and is well tolerated.

Patients with hypertension have a higher resting blood pressure than the body needs. The blood pressure needs to be lowered to avoid cardiovascular complications such as heart attacks, strokes and heart failure. There are a number of different treatments available. It is believed that combining these drugs can be more effective than prescribing them one at a time (monotherapy). Combination therapy can lead to a more rapid decrease in blood pressure.

A combination of lercanidipine and enalapril can lower elevated blood pressure, lower the risk of cardiovascular complications and reduce the risk of ankle edema. Ankle edema is a swelling of the ankles, feet and lower legs and is a common side-effect with some treatments for hypertension. 

Patients with stage 2 hypertension (blood pressure higher than 160/100 mmHg) were enrolled in this study. Patients were randomly assigned to one of nine groups. One group received a placebo (substance with no effect on the body). Two groups received either lercanidipine monotherapy or enalapril monotherapy. Other groups received combinations of lercanidipine/enalapril at different dosages. Blood pressure was routinely measured both at home or at the study office.

All dosages of the combination therapy lead to significant decreases in blood pressure in the office when compared to the placebo. Both combination and monotherapies were more effective at lowering blood pressure at home compared to the placebo.

The most effective treatment was a combination of 20 mg lercanidipine and 20 mg enalapril. Office diastolic blood pressure (pressure when the heart is between beats) decreased by 15.2 mmHg. Systolic blood pressure (pressure when the heart is contracting) decreased by 19.2 mmHg. Similar effects were seen when blood pressure was measured at home. 

This study concluded that a combination of 20 mg lercanidipine and 20 mg enalapril can significantly lower blood pressure in patients with stage 2 hypertension. No additional side effects were seen with this treatment when compared to monotherapy or other dosages of the combination. 

A notable decrease in blood pressure in the office was seen in the group receiving the placebo. Almost of the patients in this study were Caucasian.  

Consult with your physician for advice on possible treatment options for hypertension.