[Conversion from oral ACE inhibitor to intravenous quinaprilat administration in mild to moderate essential hypertension]. / Umstellung oraler ACE-Hemmer auf intravenös verabreichtes Quinaprilat bei leichter bis mittelschwerer essentieller Hypertonie.

AIM: This study was designed to evaluate the efficacy of intravenous quinaprilat in maintaining blood pressure control and to assess the safety of directly switching from oral angiotensin-converting enzyme (ACE) inhibitors to intravenous quinaprilate. PATIENTS AND METHOD: Following an initial 1-day open-label phase, patients with essential mild to moderate hypertension controlled by ACE inhibitor monotherapy were randomly assigned to treatment with intravenous quinaprilate (n = 36) or oral quinapril (n = 19) for a 3-day double-blind period. Quinaprilate (2.5, 5, or 10 mg BID) and quinapril (10, 20, or 40 mg OD) dosages were based on the patient's previous ACE inhibitor doses. The intravenously used dosages were half the dosages of orally administered enalapril, lisinopril and quinapril. Patients returned to their previous ACE inhibitor therapy during a second 1-day open-label phase. RESULTS: Quinaprilate and quinapril maintained diastolic blood pressure control at levels comparable to those during the initial open-label ACE inhibitor treatment. The mean difference between quinaprilate and quinapril treatment groups in diastolic blood pressure showed no clinically relevant differences between treatment groups with regard to mean changes from baseline. Mean reductions in systolic blood pressure were similar to those of diastolic blood pressure. CONCLUSION: Quinaprilate, at half the dose of quinapril, administered BID maintains blood pressure control, is well tolerated, and allows for safe conversion from previously applied oral ACE inhibitors. This finding is important for the antihypertensive treatment of patients in intensive care units or peri/post-operatively who cannot swallow orally administered drugs.

Efficacy and safety of benazepril plus hydrochlorothiazide versus benazepril alone in hypertensive patients unresponsive to benazepril monotherapy.

A combination of benazepril 10 mg plus hydrochlorothiazide 12.5 mg once daily was investigated in the treatment of patients with mild-to-moderate essential hypertension who had not responded to monotherapy with benazepril 10 mg. Patients failing to respond to 4 weeks of benazepril 10 mg/d were randomized to continue with the monotherapy (n = 47) or receive the combination therapy (n = 46). After 4 weeks of double-blind treatment, reductions in blood pressure were significantly greater among patients given the combination than among those receiving benazepril alone: a 4.7 +/- 1.5 mm Hg difference in mean sitting diastolic blood pressure was noted in favor of the combination therapy (P = 0.0037). The incidence of adverse events, particularly cough, was lower with benazepril + hydrochlorothiazide than with benazepril alone; no notable changes in body weight or heart rate were seen in either group.