Combination therapy with lercanidipine and enalapril in the management of the hypertensive patient: an update of the evidence

Abstract

Hypertension is an important risk factor for premature death as it increases the probability of stroke, myocardial infarction, and heart failure. Antihypertensive drugs can decrease cardiovascular (CV) morbidity and mortality. The majority of hypertensive patients need more than one antihypertensive agent to attain blood pressure (BP) targets. Monotherapy can effectively reduce BP only in 20%–40% of patients. Multiple mechanisms including increased peripheral vascular resistance, increased cardiac work, and hypervolemia are involved in the pathogenesis of hypertension. Targeting multiple pathways may more potently reduce BP. Increasing the dose of a single agent in many cases does not provide the expected BP-lowering effect because the underlying mechanism of the BP increase is either different or already corrected with the lower dose. Moreover, drugs acting on different pathways may have synergistic effects and thus better control hypertension. It is well known that diuretics enhance the actions of renin–angiotensin aldosterone system and activate it as a feedback to the reduced circulated blood volume. The addition of a renin–angiotensin aldosterone system blocker to a diuretic may more effectively reduce BP because the system is upregulated. Reducing the maximal dose of an agent may also reduce possible side effects if they are dose dependent. The increased prevalence of peripheral edema with higher doses of calcium channel blockers (CCBs) is reduced when renin–angiotensin aldosterone system blockers are added to CCBs through vein dilation. The effectiveness of the combination of enalapril with lercanidipine in reducing BP, the safety profile, and the use of the combination of angiotensin-converting enzyme inhibitors with CCBs in clinical trials with excellent CV hard end point outcomes make this combination a promising therapy in the treatment of hypertension.

Comparison Between Lercanidipine and Amlodipine for Efficacy and Tolerability in Patients with Hypertension

“…A few examinations have proposed other potential components. One theory recommends that lercanidipine causes lesser veno-tightening than different medications because of lower thoughtful initiation [11]. Fogari et al contemplated this distinction by assessing serum levels of norepinephrine.…”

AT1-receptor response to non-saturating Ang-II concentrations is amplified by calcium channel blockers

“…When calcium channels blockers are used as mono-therapy, the possibility for stimulation of AT 1 R signaling should be taken into account. Notably, a recent meta-analysis, based on more than 40 studies, has shown that combination therapy that targets both the angiotensin system and the voltage gated calcium channels, will provide a better blood pressure control than mono-therapy that acts at one of these targets [ 40 ].…”

All About Fixed-Dose Combination Lercanidipine/Enalapril: Ten Questions and Answers

“…In patients with low-moderate hypertension, Lercanidipine/Enalapril combination, significantly reduces SBP and DBP, assessed either as office BP, home BP or 24-hours BP monitoring. This effect is associated with high rate (45.0%-69.6%) of responder patients (SBP/ DBP decrease >20 mmHg/ 10 mmHg) or subjects with normal BP values 17,18 . The therapeutic efficacy of the combination has also been demonstrated in elderly 19 , in diabetic patients 20 and in obese subjects 21,22 .…”