Comparison of the antihypertensive effects of the fixed dose combination enalapril 10 mg/nitrendipine 20 mg vs losartan 50 mg/hydrochlorothiazide 12.5 mg, assessed by 24-h ambulatory blood pressure monitoring, in essential hypertensive patients

Superiority of combination of thiazide with angiotensin-converting enzyme inhibitor or AT1-receptor blocker over thiazide alone on renoprotection inl-NAME/SHR

“…Therefore, this study further confirmed previous reports (5,6,9,14,31,37,38,40) that an ACE inhibitor or ARB combined with the thiazide provides better blood pressure control. Moreover, this study is the first to provide clear evidence of the profound benefits of combination therapy of HCTZ with enalapril and/or losartan on glomerular dynamics and renal functions in an experimental model of hypertension and severe renal injury.…”

“…Indeed, the renal benefits of combination therapy have been less addressed in those clinical studies, even though this combination therapy has been advocated clinically for their potentiating effect on blood pressure reduction (5,6,9,14,31,37). Furthermore, animal studies investigating the effects of administration of a thiazide with an ACE inhibitor and/or an ARB on kidney by using renal micropuncture techniques have not been reported, despite the fact that this combination shows greater blood pressure reduction in experimental models of hypertension (38, 40).…”

“…thiazide diuretic; ANG II type 1-receptor blocker; renal effect ACCORDING TO THE Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial data (1) and the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (3), thiazide diuretics are preferred for initial antihypertensive therapy, although the angiotensin-converting enzyme (ACE) inhibitor or ANG II type 1-receptor blocker (ARB) possesses renoprotective actions (33). However, combination therapy is frequently required to obtain optimal blood pressure control for which the thiazide diuretic has been suggested as its basis (3).Several clinical trials have clearly demonstrated that, in most cases, the combination of hydrochlorothiazide (HCTZ) with an ACE inhibitor and/or an ARB are safe and probably more effective than either agent when used alone for controlling blood pressure (5,6,9,14,31,37), thereby affording greater cardioprotection (14). Indeed, the renal benefits of combination therapy have been less addressed in those clinical studies, even though this combination therapy has been advocated clinically for their potentiating effect on blood pressure reduction (5,6,9,14,31,37).…”

“…Several clinical trials have clearly demonstrated that, in most cases, the combination of hydrochlorothiazide (HCTZ) with an ACE inhibitor and/or an ARB are safe and probably more effective than either agent when used alone for controlling blood pressure (5,6,9,14,31,37), thereby affording greater cardioprotection (14). Indeed, the renal benefits of combination therapy have been less addressed in those clinical studies, even though this combination therapy has been advocated clinically for their potentiating effect on blood pressure reduction (5,6,9,14,31,37).…”

Combination therapy in hypertension: An update

“…ARB/diuretic is similarly effective to ACEI/CCBs in controlling 24 hours BP on ambulatory blood pressure monitoring but less effective in achieving SBP < 140 mm Hg and also associated with poorer metabolic control and new onset diabetes as discussed above [60]. …”