Treatment of patients with essential hypertension: amlodipine 5 mg/benazepril 20 mg compared with amlodipine 5 mg, benazepril 20 mg, and placebo

Kuschnir, E; Acuña, Enzo; Sevilla, David Fernández de; Vásquez, Jesús; Boccadoro, Mario; Resk, Jorge; Glazer, Robert

doi:10.1016/s0149-2918(96)80076-2

Cited by 59 publications

(45 citation statements)

References 8 publications

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“…These findings are in agreement with previous observations based on spontaneously reported side effects in clinical trials [8][9][10][11] and confirm and extend those of Weir et al, 22 who also used the water displacement technique to evaluate the effects of benazepril on the lower extremity oedema because of amlodipine.…”

Section: Discussionsupporting

confidence: 92%

“…In this study, the addition of benazepril to amlodipine provided greater BP reduction than either drug alone, which confirms previous observations. [6][7][8][9][10][11] In conclusion, the results of this study indicate that in patients with mild to moderate essential hypertension the addition of the ACE-I benazepril to the dihydropyridine Ca-antagonist amlodipine attenuated lower extremity oedema and provided better BP control, which strengthens the rationale to use an ACE-I/Ca-antagonist combination in the treatment of hypertension. Effect of benazepril -amlodipine combination on ankle oedema…”

Section: Discussionsupporting

confidence: 63%

“…6,7 In particular, the ACE-I/Ca antagonist combination has been shown to reduce the incidence of the most common side effect of dihydropyridine Ca-antagonists, ankle oedema. [8][9][10][11] Although the precise mechanisms causing the Ca-antagonist-induced oedema are still not completely understood, the most likely reason appears to be an increase in capillary hydrostatic pressure with consequent transcapillary fluid loss that results from a relatively more pronounced vasodilation in precapillary than postcapillary resistance vessels. [12][13][14] It has also been suggested that the Ca-antagonist-related oedema could be partly ascribed to interference by these drugs with the local vascular control (probably the myogenic component) that operates to protect dependent vascular regions from increased fluid filtration, 15,16 whereas sodium retention and activation of the renin-angiotensin system seem to play a minor role.…”

Section: Introductionmentioning

confidence: 99%

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Effect of benazepril addition to amlodipine on ankle oedema and subcutaneous tissue pressure in hypertensive patients

et al. 2003

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The aim of this study was to evaluate the effect of benazepril addition to amlodipine antihypertensive treatment on ankle-foot volume (AFV) and pretibial subcutaneous tissue pressure (PSTP), two objective measures of ankle oedema. A total of 32 mild to moderate essential hypertensives (DBP490 and o110 mmHg), aged 30-70 years were studied. After a 4-week placebo period, they were randomized to amlodipine 5 mg o.d. or benazepril 10 mg o.d. or amlodipine 5 mg plus benazepril 10 mg o.d. for 4 weeks, according to a crossover design. At the end of the placebo period and of each active treatment period, blood pressure,AFV and PSTP were evaluated. AFV was measured using the principle of water displacement. PSTP was assessed using a system, the subcutaneous pretibial interstitial enviroment with a water manometer. Both amlodipine and benazepril monotherapy significantly reduced SBP (À18.2 7 4 and À17.8 7 4 mmHg, respectively, Po0.01 vs baseline) and DBP (À12.1 7 3 and À11.7 7 3 mmHg, respectively, Po0.01); the reduction was increased by the combination (À24.2 7 5 mmHg for SBP, Po0.001 and À16.8 7 4 mmHg for DBP, Po0.001). Amlodipine monotherapy significantly increased both AFV (+17.1%, Po0.001 vs baseline) and PSTP (+56.6%, Po0.001 vs baseline). As compared to amlodipine alone, the combination produced a less pronounced increase in AFV (+5.5%, Po0.05 vs baseline and Po0.01 vs amlodipine) and PSTP (+20.5%, Po0.05 vs baseline and Po0.01 vs amlodipine). Ankle oedema was clinically evident in 11 patients with amlodipine monotherapy and in three patients with the combination. These results suggest that ACE-inhibitors partially counteract the microcirculatory changes responsible for Ca-antagonists-induced oedema formation.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 63%

Section: Introductionmentioning

confidence: 99%

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Effect of benazepril addition to amlodipine on ankle oedema and subcutaneous tissue pressure in hypertensive patients

et al. 2003

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“…These findings are similar to previous observations with the ACE-I/CCB combination, both based on spontaneously reported side effects in clinical trials [9][10][11][12] and also on the use of the water displacement technique. 13,14 The mechanisms by Valsartan-amlodipine combination and ankle oedema R Fogari et al which ARB may attenuate the CCB-induced oedema are not clear but possibly resemble those hypothesized for ACE-I.…”

Section: Discussionsupporting

confidence: 91%

“…6 By contrast, adding an angiotensin-converting enzyme inhibitor (ACE-I) to the treatment with a CCB has been shown to reduce the incidence and the entity of ankle oedema. [9][10][11][12][13] The mechanisms by which ACE-I attenuate the CCBinduced oedema are not clear, but their ability to dilate venous capacitance vessels seems to play a major role by normalizing intracapillary pressure and reducing fluid exudation from the intracapillary space into the interstitium. 6,14 Whether this ability is peculiar of ACE-I or extends to the other drugs interfering with the renin-angiotensin-aldosterone system (RAAS), that is the angiotensin receptor blockers (ARB), remains to be established.…”

Section: Introductionmentioning

confidence: 99%

Effect of valsartan addition to amlodipine on ankle oedema and subcutaneous tissue pressure in hypertensive patients

et al. 2007

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The aim of this study was to assess the effect of valsartan addition to amlodipine on ankle foot volume (AFV) and pretibial subcutaneous tissue pressure (PSTP), two objective measures of ankle oedema. After a 4-week placebo period, 80 grade 1-2 hypertensive patients (diastolic blood pressure (DBP)490 mm Hg and o110 systolic blood pressure (SBP)4140 mm Hg) were randomized to amlodipine 10 mg or valsartan 160 mg or amlodipine 10 mg plus valsartan 160 mg for 6 weeks according to an open-label, blinded end point, crossover design. At the end of the placebo period and of each treatment period, blood pressure, AFV and PSTP were evaluated. AFV was measured using the principle of water displacement. PSTP was assessed connecting the subcutaneous pretibial interstitial environment with a water manometer. Both amlodipine and valsartan monotherapy significantly reduced SBP (À16.9 and -14.5 mm Hg, respectively, Po0.01 vs baseline), and DBP (À12.9 and À10.2 mm Hg, respectively, Po0.01 vs baseline) but the reduction was greater with the combination (À22.9 mm Hg for SBP, Po0.01 vs monotherapy; À16.8 mm Hg for DBP, Po0.01 vs monotherapy). Amlodipine monotherapy significantly increased both AFV ( þ 23%, Po0.01 vs baseline) and PSTP ( þ 75.5%, Po0.001 vs baseline) whereas valsartan monotherapy did not influence them. As compared to amlodipine alone, the combination produced a less marked increase in AFV ( þ 6.8%, Po0.01 vs amlodipine) and PSTP ( þ 23.2%, Po0.001 vs amlodipine). Ankle oedema was clinically evident in 24 patients with amlodipine and in six patients with the combination. These results suggest that angiotensin receptor blockers partially counteract the microcirculatory changes responsible for calcium channel blockers induced oedema formation.

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Blood pressure lowering efficacy of angiotensin converting enzyme (ACE) inhibitors for primary hypertension

Heran

Wong

Heran

et al. 2008

Cochrane Database of Systematic Reviews

132

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There are no clinically meaningful BP lowering differences between different ACE inhibitors. The BP lowering effect of ACE inhibitors is modest; the magnitude of trough BP lowering at one-half the manufacturers' maximum recommended dose and above is -8/-5 mm Hg. Furthermore, 60 to 70% of this trough BP lowering effect occurs with recommended starting doses. The review did not provide a good estimate of the incidence of harms associated with ACE inhibitors because of the short duration of the trials and the lack of reporting of adverse effects in many of the trials.

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Treatment of patients with essential hypertension: amlodipine 5 mg/benazepril 20 mg compared with amlodipine 5 mg, benazepril 20 mg, and placebo

Cited by 59 publications

References 8 publications

Effect of benazepril addition to amlodipine on ankle oedema and subcutaneous tissue pressure in hypertensive patients

Effect of benazepril addition to amlodipine on ankle oedema and subcutaneous tissue pressure in hypertensive patients

Effect of valsartan addition to amlodipine on ankle oedema and subcutaneous tissue pressure in hypertensive patients

Blood pressure lowering efficacy of angiotensin converting enzyme (ACE) inhibitors for primary hypertension

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