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Vol 13, No 2 (2009)
Prace oryginalne
Published online: 2009-03-10
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Systematic review of clinical studies regarding clinical effectiveness of combination therapy with ramipril plus hydrochlorothiazide compared to monotherapy with ramipril and hydrochlorothiazide or combination therapy with captopril plus hydrochlorothiazide as treatment options in essential arterial hypertension

Ludwina Szczepaniak-Chicheł, Paweł Kawalec, Joanna Lis, Jakub Gierczyński, Andrzej Tykarski
Nadciśnienie tętnicze 2009;13(2):106-113.

open access

Vol 13, No 2 (2009)
Prace oryginalne
Published online: 2009-03-10

Abstract


Background Beta-blockers, diuretics, calcium antagonists, angiotensin converting enzyme inhibitors (ACE-Is) and angiotensin receptor antagonists are commonly used in monotherapy of arterial hypertension. But the majority of patients (70-80%) require treatment with more than one agent. Thiazide diuretic is recommended for two-drug therapy as it enhances a hypotensive effect of the second component. Combined use of ACE-I and thiazide diuretic results in complementary mode of action and favorable tolerability profile. Usage of combined preparations containing small doses of two adequately matched antihypertensives can be beneficial for patients compliance because of better and earlier achieved control of blood pressure with smaller number of adverse effects at the same time, than in case of monotherapy. Aim of the analysis Assessment of clinical effectiveness (hypotensive effect and tolerability) of combination therapy with ramipril plus hydrochlorothiazide compared with monotherapy of ramipril and hydrochlorothiazide or with combination therapy with captopril plus hydrochlorothiazide in blood hypertension treatment.
Material and methods Clinical assessment was performed according to PolAHTA Guidelines; analysis and credibility evaluation were based on the rules of evidence-based medicine (EBM). In order to find relevant clinical publications a systematic review of medical databases was performed.
Results Systematic review revealed 4 "head-to-head comparison" clinical trials which made it possible to compare clinical efficacy and safety of analysed interventions. Meta-analysis of two trials revealed a statistically significant differences in blood pressure lowering effect in patients treated with combination of ramipril plus hydrochlorotiazide compared to monotherapy with ramipril or hydrochlorothiazide and combination therapy with captopril and hydrochlothiazide.
Conclusions Ramipril plus hydrochlorothiazide has stronger hypotensive effect than monotherapy with each of those drugs. Moreover, such combination therapy significantly decreased the risk of lack of response to antihypertensive treatment compared to monotherapy with ramipril or hydrochlorothiazide alone. It was also shown that combination of ramipril and hydrochlorothiazide is far more effective in maintenance of achieved target blood pressure than captopril and hydrochlorothiazide. Lastly, depending on the type of adverse event the risk of such was lower or similar in two-drug treatment regiment based on ramipril compared with monotherapy with its components or combination therapy based on captopril.

Abstract


Background Beta-blockers, diuretics, calcium antagonists, angiotensin converting enzyme inhibitors (ACE-Is) and angiotensin receptor antagonists are commonly used in monotherapy of arterial hypertension. But the majority of patients (70-80%) require treatment with more than one agent. Thiazide diuretic is recommended for two-drug therapy as it enhances a hypotensive effect of the second component. Combined use of ACE-I and thiazide diuretic results in complementary mode of action and favorable tolerability profile. Usage of combined preparations containing small doses of two adequately matched antihypertensives can be beneficial for patients compliance because of better and earlier achieved control of blood pressure with smaller number of adverse effects at the same time, than in case of monotherapy. Aim of the analysis Assessment of clinical effectiveness (hypotensive effect and tolerability) of combination therapy with ramipril plus hydrochlorothiazide compared with monotherapy of ramipril and hydrochlorothiazide or with combination therapy with captopril plus hydrochlorothiazide in blood hypertension treatment.
Material and methods Clinical assessment was performed according to PolAHTA Guidelines; analysis and credibility evaluation were based on the rules of evidence-based medicine (EBM). In order to find relevant clinical publications a systematic review of medical databases was performed.
Results Systematic review revealed 4 "head-to-head comparison" clinical trials which made it possible to compare clinical efficacy and safety of analysed interventions. Meta-analysis of two trials revealed a statistically significant differences in blood pressure lowering effect in patients treated with combination of ramipril plus hydrochlorotiazide compared to monotherapy with ramipril or hydrochlorothiazide and combination therapy with captopril and hydrochlothiazide.
Conclusions Ramipril plus hydrochlorothiazide has stronger hypotensive effect than monotherapy with each of those drugs. Moreover, such combination therapy significantly decreased the risk of lack of response to antihypertensive treatment compared to monotherapy with ramipril or hydrochlorothiazide alone. It was also shown that combination of ramipril and hydrochlorothiazide is far more effective in maintenance of achieved target blood pressure than captopril and hydrochlorothiazide. Lastly, depending on the type of adverse event the risk of such was lower or similar in two-drug treatment regiment based on ramipril compared with monotherapy with its components or combination therapy based on captopril.
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Keywords

arterial hypertension; thiazide diuretic; angiotensin converting enzyme inhibitor; monotherapy; combined therapy

About this article
Title

Systematic review of clinical studies regarding clinical effectiveness of combination therapy with ramipril plus hydrochlorothiazide compared to monotherapy with ramipril and hydrochlorothiazide or combination therapy with captopril plus hydrochlorothiazide as treatment options in essential arterial hypertension

Journal

Arterial Hypertension

Issue

Vol 13, No 2 (2009)

Pages

106-113

Published online

2009-03-10

Bibliographic record

Nadciśnienie tętnicze 2009;13(2):106-113.

Keywords

arterial hypertension
thiazide diuretic
angiotensin converting enzyme inhibitor
monotherapy
combined therapy

Authors

Ludwina Szczepaniak-Chicheł
Paweł Kawalec
Joanna Lis
Jakub Gierczyński
Andrzej Tykarski

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