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This 12-week randomized, parallel-group, multicenter study compared fixed combinations of delapril (D) 30 mg plus indapamide (I) 2.5 mg and fosinopril (F) 20 mg plus hydrochlorothiazide (H) 12.5 mg in 171 adult patients with mild to moderate essential hypertension. After a 2-week placebo run-in, sitting and standing systolic (SBP) and diastolic blood pressure (DBP) was measured by conventional sphygmomanometry. The primary efficacy endpoint was the percentage of normalized (sitting DBP < or =90 mm Hg) and responder (sitting DBP reduction of 10 mm Hg or DBP < or =90 mm Hg) patients. Treatment effects were analyzed in the intention-to-treat (ITT; n = 171) and the per-protocol (PP; n = 167) populations. The percentage of normalized and responder patients did not differ significantly between the D + I (87.4% and 92%) and the F + H (81% and 86.9%) ITT groups. Similar results were seen in the PP population. In ITT and PP patients, sitting and standing SBP and DBP values were comparable at baseline in the two groups and were significantly (P<.01) and similarly reduced at weeks 4, 8, and 12. Neither treatment induced reflex tachycardia, and both regimens were well tolerated. Four patients in the F + H group dropped out because of adverse events. In this study, the efficacy and safety of D + I were comparable to those of F + H in patients with mild to moderate essential hypertension.

Background: Several studies have shown that antihypertensive monotherapy is commonly insufficient to control blood pressure (BP) in hypertensive patients and that concomitant use of Ն2 drugs is necessary in ∼50% of these patients. The combination of an angiotensin-converting enzyme (ACE) inhibitor and a diuretic, delapril plus indapamide (DϩI), has been shown to be effective and tolerable, with no interaction between the 2 components. Another widely used combination of ACE inhibitor and diuretic is lisinopril plus hydrochlorothiazide (LϩH).Objectives: The aims of this study were to confirm the antihypertensive efficacy and tolerability of the fixed combination of DϩI in mild to moderate hypertension, and to compare its therapeutic efficacy and tolerability with that of LϩH.Methods: The antihypertensive efficacy and tolerability of a fixed combination of DϩI (30-mg ϩ 2.5-mg tablets once daily) or LϩH (20-mg ϩ 12.5-mg tablets once daily) in patients with mild to moderate hypertension were compared in a multinational, multicenter, randomized, 2-armed, parallel-group study. Eligible patients were aged 18 to 75 years and had a diastolic blood pressure (DBP) 95 to 115 mm Hg and a systolic blood pressure (SBP) Յ180 mm Hg, both measured in the sitting position. After a single-blind, placebo run-in period of 2 weeks, patients were randomized to receive 1 of the 2 treatments for a 12-week period. The primary efficacy end point was the BP normalization Key words: hypertension, delapril, indapamide, lisinopril, hydrochlorothiazide, combination therapy. INTRODUCTIONHypertension represents one of the most common risk factors for cardiovascular disease, the major cause of mortality and disability in industrialized countries. The results of 2 clinical studies 1,2 have demonstrated that blood pressure (BP) reduction provides benefits in terms of reduced cardiovascular mortality and morbidity, and the scientific community recommends early diagnosis and aggressive therapy for hypertension. 3,4 The major goal in the treatment of hypertensive patients should be normalization of BP; 1 trial 5 also has shown that the incidence of cardiovascular complications is often higher in treated hypertensive patients than in matched normotensive subjects.Several studies 3,4,6 conducted to identify the ideal antihypertensive drug have shown that monotherapy is commonly insufficient to control BP in hypertensive patients and that concomitant use of Ն2 drugs is necessary in ∼50% of these patients. Moreover, in addition to the superior therapeutic efficacy of this approach, the concomitant administration of antihypertensive drugs with different mechanisms of action allows dose decreases with the associated advantage of reduction of adverse events (AEs). 3,4 Among antihypertensive therapies, angiotensin-converting enzyme (ACE) inhibitors have become widely used therapeutic agents; in particular, a common approach is the combined administration of an ACE inhibitor and a diuretic. 7

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Decreased myocardial function results in a more symmetrical outflow, while very asymmetrical traces suggest increased contractility, potentially inducing intra-cavity gradients during DSE. Therefore, including outflow symmetry as a clinical measurement provides additional information on patients with CAD.

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