Once vs twice daily administration of a fixed combination of captopril plus hydrochlorothiazide in essential hypertension: a double‐blind crossover study in known responders to a standard combination.

Abstract

The purpose of this randomized, double-blind, crossover trial was to compare the hypotensive effects of a fixed combination of captopril (C) 50 mg and hydrochlorothiazide (HCTZ) 25 mg (C 50/HCTZ 25) once daily with those of a fixed combination of C 25 mg and HCTZ 12.5 mg (C 25/HCTZ 12.5) twice daily. We studied 199 patients (108 M, 91 F) with mild to moderate essential hypertension whose BP was already controlled by the co-administration of C 25 mg and HCTZ 12.5 mg twice daily. They were randomly assigned to either C 25/HCTZ 12.5 twice daily during the first 6 weeks and C 50/HCTZ 25 once daily during the second 6 weeks or C 50/HCTZ 25 once daily followed by C 25/ HCTZ 12.5 twice daily. Both regimens showed comparable efficacy on office diastolic BP (91.6 vs 91.3 mm Hg). Systolic BP was slightly but significantly higher (P = 0.02) with the once daily formulation (141.2 vs 139.1 mm Hg). Fixed combinations once daily and twice daily resulted in identical working ambulatory BP (133.7 ± 13/83.6 ± 8 mm Hg vs 132.4 ± 11/ 83.3 ± 7 mm Hg) without affecting heart rate. Adverse events were reported by 16% of patients and cough was the most common occurring in 7%. In conclusion, these results indicate that the fixed combination of C 50/HCTZ 25 given once daily controls office and working BP as well as the fixed combination C 25/HCTZ 12.5 given twice daily in patients with mild to moderate hyptertension.

Attenuation of angiotensin converting enzyme inhibitor induced cough by iron supplementation: role of nitric oxide

“…Previous studies have reported the incidence of ACE-I induced cough to be as low as 5% 1 to as high as 39%. 2 In the ADOPT and ASCEND trials, it has been reported that the highest incidence of cough is among Asians. 17 The present observation is in agreement with these findings.…”

“…In spite of their increasing use, these drugs produce various side effects, of which the most troublesome and frequent is the production of persistent dry cough. 1,2 The incidence of ACE-I induced cough has been reported to range between 5% 1 and 39%. 2 Study by Vegter and de Jong-van den Berg 3 suggested that cough as a side effect of ACE-I is being missed and patients are treated with anti-tussive agents with an estimated frequency of 15%.…”

“…1,2 The incidence of ACE-I induced cough has been reported to range between 5% 1 and 39%. 2 Study by Vegter and de Jong-van den Berg 3 suggested that cough as a side effect of ACE-I is being missed and patients are treated with anti-tussive agents with an estimated frequency of 15%. Mooraki et al 4 have shown earlier that noscapine as an anti-tussive agent is beneficial in ACE-I induced cough per se as it inhibits the effect of bradykinin.…”

A Tosse Dos Iecas É Realmente Um Fator Limitante

“…Em geral desaparece em até quatro dias da sua retirada, porém artigos referem quatro semanas para cessação da mesma. 8 A prevalência da tosse variou no estudo de Rumbolt et al 9 de 0% até 90% no estudo de Lacouciére et al 10 ambos estudos com captopril e enalapril. Na maioria dos estudos a substituição de um IECAs por outro IECAs não resolveu a tosse.…”

“…4,5,8 Estudos mais recentes e mais ampliados em termos de população e acompanhamento, bem como duplo cego, dão conta que a tosse varia de 5 a 10%. 14,15 No estudo de Lacourcière et al 10 mostraram em pacientes usando lisinopril a mesma foi retirada e reintroduzida em um estudo duplo cego. Neste caso somente 50% no braço de lisinopril comparado com 29% no braço do losartana (BRA) apresentaram tosse.…”