Antihypertensive Treatment in Postmenopausal Women: Results from a Prospective, Randomized, Double-Blind, Controlled Study Comparing an ACE Inhibitor (Moexipril) with a Diuretic (Hydrochlorothiazide)

Abstract

The present study was designed to compare the safety and efficacy of the new angiotensin-converting enzyme inhibitor moexipril with that of hydrochlorothiazide (HCTZ) in postmenopausal women with mild-to-moderate hypertension. After a 4-week single-blind placebo period, 97 postmenopausal hypertensive women (42–74 years of age) with a sitting diastolic blood pressure (SDBP) of 95–114 mm Hg were randomized to receive either once daily moexipril 15 mg or HCTZ 25 mg for a 12-week double-blind treatment period. At study endpoint, HCTZ caused significantly greater increases from baseline in serum uric acid levels than did moexipril (0.8 ± 0.1 vs. 0.1 ± 0.1 mg/dl, p < 0.01). Furthermore, 12-week treatment with HCTZ resulted in significant increases in glucose (+11.0 ± 4.1 mg/dl) and total cholesterol/HDL ratio (+0.3±0.1 mg/dl) and a significant decrease in HDL (–3.2±0.7 mg/dl). In contrast, moexipril treatment was not associated with significant changes in any metabolic parameter. Both drugs efficiently lowered SDBP with reductions of –10.0 ± 1.3 and –11.8 ± 1.1 mm Hg in the moexipril and HCTZ group, respectively. Clinical adverse events were reported by a greater percentage of HCTZ patients (53%) than moexipril patients (40%), with headache and rhinitis as the most frequent events. The results indicate that moexipril was better tolerated than HCTZ in postmenopausal women and did not adversely affect metabolic parameters. Both drugs were effective in lowering blood pressure.

Pharmacological and Clinical Profile of Moexipril: A Concise Review

“…The antihypertensive effectiveness and safety of moexipril have also been compared with other antihypertensive drugs in patients with mild to moderately severe hypertension (SDBP 95–114 mmHg). In comparison with hydrochlorothiazide 25 mg once daily, atenolol 25 to 50 mg once daily, metoprolol 100 mg once daily, verapamil sustained release (SR) 120 to 240 mg once daily, nitrendipine 20 mg once daily, and captopril 25 to 50 mg twice daily, moexipril given in single daily doses of 7.5 to 15 mg was as effective in lowering blood pressure as the other antihypertensive drugs 50–55 . The results of these studies are displayed in Table III.…”

“…In comparison with hydrochlorothiazide 25 mg once daily, atenolol 25 to 50 mg once daily, metoprolol 100 mg once daily, verapamil sustained release (SR) 120 to 240 mg once daily, nitrendipine 20 mg once daily, and captopril 25 to 50 mg twice daily, moexipril given in single daily doses of 7.5 to 15 mg was as effective in lowering blood pressure as the other antihypertensive drugs. [50][51][52][53][54][55] The results of these studies are displayed in Table III.…”

Distinct effects of fixed combinations of valsartan with either amlodipine or hydrochlorothiazide on lipoprotein subfraction profile in patients with hypertension

“…24 Thiazides normally exhibit a neutral effect on HDL-C levels with few reports of a slight decrease. 20,32 ARBs also seem not to exert significant alterations in HDL-C levels with the exception of reports showing a mild increase. 20,31 Also, the reduction in HDL-C levels together with the rise in TG levels could serve as potential 'indicator' of the increased sdLDL cholesterol concentration in this group.…”

Effects of losartan compared with atenolol on lipids in patients with hypertension and left ventricular hypertrophy: the Losartan Intervention For Endpoint reduction in hypertension study

“…HDL-C decreased over the first 2 years and then increased throughout the study, but stayed lower than the baseline value. Even though we were not able to demonstrate lower HDL-C in patients receiving hydrochlorothiazide treatment, which was used in a large majority of patients, we cannot rule out an effect of initiation of hydrochlorothiazide treatment [6,[16][17][18][19] that occurred during the same time period.…”