Enalapril in moderate to severe hypertension: a comparison with atenolol.

Abstract

Patients with moderate to severe essential hypertension (mean untreated supine blood pressure 190/112 mm Hg) received once daily enalapril 20‐ 40 mg or atenolol 50‐100 mg, supplemented if required by hydrochlorothiazide 25‐100 mg, in a randomized observer‐blind trial. Both regimens produced a highly significant reduction in supine and standing blood pressure. There was no significant difference in the antihypertensive effects of enalapril and atenolol when they were used as monotherapy. After hydrochlorothiazide was added to patients not achieving ‘target’ blood pressure, the fall in systolic pressure was significantly greater in the enalapril group than in the atenolol group, despite similar dosage of hydrochlorothiazide in the two groups. At the end of 6 months' treatment, a supine diastolic blood pressure of 90 mm Hg or below was achieved in 74% of patients on enalapril plus hydrochlorothiazide and 56% of patients on atenolol plus hydrochlorothiazide. This difference was not statistically significant. A small rise in plasma urea and creatinine was observed in the enalapril group and a small rise of urea only in the atenolol group. These changes were statistically significant but of uncertain clinical importance. This study confirms that once daily enalapril and atenolol, both alone and in combination with hydrochlorothiazide, are effective drugs in the management of moderate to severe hypertension.

Studies on Effect of Atenolol and Enalapril on Serum Electrolytes in Pre and Postmenopausal Women with Essential Hypertension

“…[19] A study conducted for analysis of relationship between sodium status and ACE-inhibitor efficacy reported that sodium depletion boosts renin secretion from the juxtaglomerular cells which leads to increase in the hypotensive effect of ACE-inhibitor. [20] Postmenopausal women are especially salt sensitive. Tubular reabsorption of sodium is increased in these patients, which inhibits renin release, which decreases efferent arteriolar vasoconstriction leading to increased renal blood flow due to increased sodium excretion.…”

Psychotropic effects of repeated doses of enalapril, propranolol and atenolol in normal subjects.

“…Some studies report a decrease in alertness with propranolol (e.g. Salem & McDevitt, 1984), another found mood-elevating and calming effects (Landauer et al, 1979) but most detected no major subjective effects (Webster et al, 1986). Atenolol in high dose (40 mg) exercised a transient calming effect (Salem & McDevitt, 1984).…”

“…Chrysant et al, 1983;Webster et al, 1986;Zezulka et al, 1987). Enalapril is administered orally, is itself inactive and undergoes hepatic deesterification to enalaprilat.…”

The Place of Angiotensin-Converting Enzyme Inhibitors in Internal Medicine

“…With regard to mortality and morbidity, we really have no data on the effect of ACE inhibitors; we do know that they reduce blood pressure very adequately, producing the same reduction in diastolic -and an even greater reduction in systolic -blood pressure than ß-blockers [2,3]. It is tempting to as sume that a given reduction in blood pres sure produces the same mortality/morbidity benefit, irrespective of which drug is used.…”