Fixed combinations of delapril plus indapamide vs fosinopril plus hydrochlorothiazide in mild to moderate essential hypertension

Cremonesi, G; Cavalieri, Luca; Čikeš, Ivo; Dobovišek, Jurij; Bacchelli, Stefano; Esposti, Daniela Degli; Costa, Francesco; Borghi, Claudio; Ambrosioni, Ettore

doi:10.1007/bf02850269

Cited by 11 publications

(12 citation statements)

References 18 publications

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“…Several such trials have been reported in the past few years [5][6][7][8]. The same mechanism is true for ARB + diuretic combinations [9][10][11][12].…”

Section: Angiotensin-inhibiting Drugs and Diureticsmentioning

confidence: 94%

“…Much has been written in recent years about the advantages and disadvantages of using fixed drug combinations [5][6][7][8][9][10][11]13,15,[17][18][19][20][21][22][23][24][25][26][27][28][29]. There are also arguments relevant to the proper timing of instituting a chosen fixed combination-that is, as first choice upon initiation of drug therapy or upon reaching the BP goal, after which no further changes are likely to be needed [31][32][33][34][35].…”

Section: Fixed Drug Combinationsmentioning

confidence: 99%

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Combination therapy as first-line treatment for hypertension

Gavras

Rosenthal

2004

Current Science Inc

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With the cut-off point between "normal" and "high" blood pressure (BP) being pushed increasingly downward, especially for patients with multiple cardiovascular risk factors, most hypertensives need more than one antihypertensive agent to reach their target BP. In this article, we examine the rationale for combining drugs from different classes that have synergistic or additive effects and properties that might offset one another's adverse hemodynamic and/or metabolic reactions. We suggest circumstances in which the initiation of therapy with a fixed two-drug combination might be preferable to the usual practice of starting with monotherapy followed by upward titration and addition of other agents, and we briefly review the existing fixed drug combinations. We end with the intriguing and provocative notion of the future "polypill," a fixed combination of agents addressing various components of the metabolic syndrome as well as other coexisting common risk factors in both high-risk patients with conditions requiring polypharmacy and in healthy, asymptomatic individuals.

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“…Several such trials have been reported in the past few years [5][6][7][8]. The same mechanism is true for ARB + diuretic combinations [9][10][11][12].…”

Section: Angiotensin-inhibiting Drugs and Diureticsmentioning

confidence: 94%

Section: Fixed Drug Combinationsmentioning

confidence: 99%

Combination therapy as first-line treatment for hypertension

Gavras

Rosenthal

2004

Current Science Inc

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“…failure have been studied mainly in adults, but these are assumed Reported pediatric experience with ACE inhibitors is limited to to be applicable in pediatric heart failure. captopril, enalapril, and cilazapril, [13] although more than ten other In heart failure, cardiac systemic output is decreased [32,33] be-ACE inhibitors have been developed and used in adults, including cause of either increased cardiac load, such as a large left-to-right alacepril, [45] benazepril, [46] delapril, [47] fosinopril, [47,48] imishunt resulting from a large ventricular septal defect in infancy, [34] dapril, [49] lisinopril, [50] perindopril, [51] quinapril, [52] ramipril, [53] or myocardial dysfunction, such as dilated cardiomyopathy temocapril, [54] and trandolapril. [55] (DCM).…”

mentioning

confidence: 99%

ACE Inhibitors in Pediatric Patients with Heart Failure

Momma

2006

Pediatric Drugs

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This article reviews reports of ACE inhibitor use in pediatric heart failure and summarizes the present implications for clinical practice. Captopril, enalapril, and cilazapril are orally active ACE inhibitors, and widely used in pediatric cardiology, although more than ten other ACE inhibitors have been applied clinically in adults. Effects of ACE inhibitors on the renin-angiotensin-aldosterone system in pediatric patients are similar to those in adults. ACE inhibitors lower aortic pressure and systemic vascular resistance, do not affect pulmonary vascular resistance significantly, and lower left atrial and right atrial pressures in pediatric patients with heart failure. In infants with a large ventricular septal defect and pulmonary hypertension, ACE inhibitors decrease left-to-right shunt in those infants with elevated systemic vascular resistance. ACE inhibitors induce a small increase in left ventricular ejection fraction, left ventricular fractional shortening, and systemic blood flow in children with left ventricular dysfunction, mitral regurgitation, and aortic regurgitation. These beneficial effects usually persist long term without the development of tolerance. Therapeutic trials of ACE inhibitors have been reported in children with heart failure and divergent hemodynamics, including myocardial dysfunction, left-to-right shunt, such as large ventricular septal defect and pulmonary hypertension, aortic or mitral regurgitation, and Fontan circulation. Hypotension and renal failure usually occur within 5 days after starting ACE inhibition or increasing the dose and, in most cases, recovery is seen after reduction or cessation of the drug. With all ACE inhibitors, smaller doses are administered initially to prevent excessive hypotension, and doses are increased gradually to the target dose. Captopril is administered orally, usually every 8 hours. Daily doses range from 0.3 to 1.5 mg/kg in children. Enalapril is administered orally, once or twice a day, and daily doses range from 0.1 to 0.5 mg/kg. Enalaprilat is administered intravenously, one to three times a day, in doses ranging from 0.01 to 0.05 mg/kg/dose. For the treatment of chronic heart failure in children, ACE inhibitors are essential along with other medications including diuretics, digoxin, and beta-blockers (beta-adrenoceptor antagonists).

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“…Since outcome measures were similar for all four studies27–30 included in the meta-analysis, we considered the definitions used in each study as follows: normalized patients were defined as showing a reduction in sitting DBP ≤ 90 mmHg at the 4-week visit27,29 or at the end of the 12-week period of treatment 28,30. Responder patients were defined as: (a) showing a reduction in sitting DBP of 15 mmHg after 1 month of treatment, compared to baseline values;27 (b) showing a reduction in sitting DBP of 10 mmHg compared to baseline values or DBP ≤ 90 mmHg after 12 weeks of treatment;28,30 or (c) demonstrating a reduction in sitting DBP of 10 mmHg from baseline after 1 month of treatment 29.…”

Section: Methodsmentioning

confidence: 99%

“…Responder patients were defined as: (a) showing a reduction in sitting DBP of 15 mmHg after 1 month of treatment, compared to baseline values;27 (b) showing a reduction in sitting DBP of 10 mmHg compared to baseline values or DBP ≤ 90 mmHg after 12 weeks of treatment;28,30 or (c) demonstrating a reduction in sitting DBP of 10 mmHg from baseline after 1 month of treatment 29. Leonetti27 reported two definitions of patient responders: (a) patients with reduction in sitting DBP of 15 mmHg and (b) a second, wider definition, which also included the definition of normalized patients.…”

Section: Methodsmentioning

confidence: 99%

Efficacy and safety of delapril/indapamide compared to different ACE-inhibitor/hydrochlorothiazide combinations: a meta-analysis

Circelli¹,

Nicolini²,

Egan³

et al. 2012

IJGM

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The main objective of this meta-analysis was to compare the efficacy of the combination of delapril and indapamide (D+I) to different angiotensin-converting enzyme inhibitor (ACEi) plus hydrochlorothiazide (HCTZ) combinations for the treatment of mild-to-moderate hypertension. A secondary objective was to examine the safety of these two combinations. Studies comparing the efficacy of D+I to ACEi+HCTZ combinations in hypertensive patients and published on computerized databases (1974–2010) were considered. Endpoints included percentage of normalized patients, of responders, change in diastolic and systolic blood pressure (DBP/SBP) at different time-points, percentage of adverse events (AEs), and percentage of withdrawal. Four head-to-head randomized controlled trials (D+I-treated, n = 643; ACEi+HCTZ-treated, n = 629) were included. Meta-analysis indicated that D+I-treated patients had a higher proportion with normalized blood pressure (P = 0.024) or responders (P = 0.002) compared to ACEi+HCTZ-treated patients. No difference was observed between treatments on absolute values of DBP and SBP at different time-points. Although the rate of patients reporting at least one AE was similar in both groups (10.4% versus 9.9%), events leading to study withdrawal were lower in the D+I group versus the ACEi+HCTZ group (2.3% versus 4.8%, respectively; P = 0.018). This meta-analysis suggests that treatment with D+I could provide a higher proportion of normalized or responder patients with good tolerability compared to ACEi+HCTZ combinations.

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Fixed combinations of delapril plus indapamide vs fosinopril plus hydrochlorothiazide in mild to moderate essential hypertension

Cited by 11 publications

References 18 publications

Combination therapy as first-line treatment for hypertension

Combination therapy as first-line treatment for hypertension

ACE Inhibitors in Pediatric Patients with Heart Failure

Efficacy and safety of delapril/indapamide compared to different ACE-inhibitor/hydrochlorothiazide combinations: a meta-analysis

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