Initial angiotensin-converting enzyme inhibitor/calcium channel blocker combination therapy achieves superior blood pressure control compared with calcium channel blocker monotherapy in patients with stage 2 hypertension*1

Jamerson, Kenneth; Nwose, Oliseyenum M.; Jean-Louis, Lisa; Schofield, Lesley; Purkayastha, Das; Baron, Michelle A.

doi:10.1016/j.amjhyper.2004.02.003

Cited by 96 publications

(42 citation statements)

References 20 publications

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“…We identified a substantial effect of A therapy (B25/11 mm Hg) and an additional BP lowering (B5/3 mm Hg) attributable to the combination of amlodipine and benazapril. The observation that BP control rates in this study are lower than those reported in other studies, 6,7 owes, at least in part, to the very high baseline SBP and DBP measurements that were present (about 175/100 mm Hg); thus, a mean decrease in SBP of 435 mm Hg and DBP of 420 mm Hg would have been necessary to achieve BP control in the majority of subjects. More important is the strict guideline-based definition of BP control that was used (o140/90 in general or o130/80 mm Hg in subjects with diabetes or CKD).…”

Section: Discussioncontrasting

confidence: 71%

“…More important is the strict guideline-based definition of BP control that was used (o140/90 in general or o130/80 mm Hg in subjects with diabetes or CKD). We have found only two studies with limited similarity: SOLACE by Jamerson et al 6 and SHIELD by Bakris et al, 7 in which BP control rates were 61 and 63%, respectively. Each of these studies was of 12 weeks in duration, whereas our study was much shorter (6 weeks).…”

Section: Discussionmentioning

confidence: 92%

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Comparative efficacy and safety of amlodipine/benazepril combination therapy and amlodipine monotherapy in severe hypertension

et al. 2009

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Section: Discussioncontrasting

confidence: 71%

Section: Discussionmentioning

confidence: 92%

Comparative efficacy and safety of amlodipine/benazepril combination therapy and amlodipine monotherapy in severe hypertension

et al. 2009

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“…First, as CCBs and RAS inhibitors effect vasodilation by different mechanisms, their antihypertensive effects are additive when used in combination. [5][6][7][8]64,65 This effect is exemplified by data from a recent trial involving amlodipine and olmesartan medoxomil, which showed that both the absolute BP reductions achieved and the rate of target BP attainment were significantly greater in patients who received combination therapy than in those who received amlodipine monotherapy. 5 It is important to note that, in contrast to many other studies, the target BP in this trial was defined using both diastolic blood pressure and systolic blood pressure (o140/90 mm Hg for the majority of patients; o130/80 mm Hg for those with diabetes).…”

Section: Other Advantages Of Ccb/ras Inhibitor Combination Therapymentioning

confidence: 85%

Mitigation of calcium channel blocker-related oedema in hypertension by antagonists of the renin–angiotensin system

Sierra

2009

J Hum Hypertens

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This review is aimed at examining calcium channel blocker (CCB)-related oedema and how this can be attenuated through the use of agents that inhibit the renin-angiotensin system. CCBs are effective antihypertensive agents, but their propensity for causing oedema may reduce compliance. A review of the literature has indicated that the absolute incidence of this side effect is difficult to determine because reported rates vary widely, a factor that may stem from differences in the surveillance technique (active vs passive). In a recent trial incorporating active surveillance, 25% of patients who received amlodipine 10 mg per day experienced oedema. CCB-induced oedema is caused by increased capillary hydrostatic pressure that results from preferential dilation of pre-capillary vessels. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) cause postcapillary dilation and normalize hydrostatic pressure, and are thus ideally suited for prevention/reversal of CCB-induced oedema. The efficacy of this strategy was proven using both subjective and objective techniques. ARB/CCB and ACEI/CCB combination therapy is also more effective than CCB monotherapy in controlling blood pressure. These combinations represent an important advance in the management of hypertension.

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“…Combining classes of agents with complementary mechanisms of action, such as CCBs and RAS blockers, provides greater BP-lowering efficacy than monotherapy, [68][69][70][71][72][73][74][75] with a comparable and potentially improved adverse-event profile. 76 However, few trials have been designed to test the effect of specific antihypertensive combinations on cardiovascular or renal end points.…”

Section: Dual Calcium Channel/ras Blockadementioning

confidence: 99%

Targeting mechanisms of hypertensive vascular disease with dual calcium channel and renin–angiotensin system blockade

Weir

2007

J Hum Hypertens

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Patients with hypertension, particularly those with diabetes mellitus, are at heightened risk for cardiovascular and renal disease. Accumulated evidence indicates that the majority of hypertensive patients at high risk will require more than one antihypertensive agent to reach their blood pressure (BP) target. A reasonable strategy is to use agents with complementary mechanisms of action to enhance BP-lowering efficacy and prevent target organ damage. In experimental models, the combination of a calcium channel blocker (CCB) with an agent that blocks the renin-angiotensin system (RAS), an angiotensinconverting enzyme (ACE) inhibitor or angiotensin receptor blocker, improves measures of endothelial function, inflammation, ventricular remodelling and renal function to a greater degree than these classes given as monotherapy. In clinical trials, calcium channel/RAS blockade combination therapy has been shown to provide greater BP reductions and improve renal function in patients with diabetic and nondiabetic renal disease earlier and to a greater extent than monotherapy. In addition, dual calcium channel/RAS blockade increases arterial compliance, arterial distensibility and flow-mediated vasodilation. Expanding upon extensive research on the benefits of calcium channel blockade and RAS blockade for the prevention of vascular events and preclinical and clinical trial evidence suggests added effects of combination therapy by targeting the underlying mechanisms of hypertensive vascular disease.

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Initial angiotensin-converting enzyme inhibitor/calcium channel blocker combination therapy achieves superior blood pressure control compared with calcium channel blocker monotherapy in patients with stage 2 hypertension*1

Cited by 96 publications

References 20 publications

Comparative efficacy and safety of amlodipine/benazepril combination therapy and amlodipine monotherapy in severe hypertension

Comparative efficacy and safety of amlodipine/benazepril combination therapy and amlodipine monotherapy in severe hypertension

Mitigation of calcium channel blocker-related oedema in hypertension by antagonists of the renin–angiotensin system

Targeting mechanisms of hypertensive vascular disease with dual calcium channel and renin–angiotensin system blockade

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