Læknablaðið - 15.06.1996, Page 15

LÆKNABLAÐIÐ 1996; 82
443
Ákjósanleg samsetning kaptópríls og
hýdróklórtíasíðs við vægum
háþrýstingi
Þóröur Harðarson”, Árni Kristinsson1’, Stefán Jökull Sveinsson21, Jóhann Ragnarsson3’
Haröarson Þ, Kristinsson Á, Sveinsson SJ, Ragnars-
son J
The optimal combinat ion of captopril and hydrochlo-
rothiazide in miid hypertension
Læknablaðið 1996; 82: 443-9
Objective: We have previously shown that in the
treatment of mild to moderate hypertension little is
gained by increasing the dose of hydrochlorothia-
zide (HCT) over 12.5 mg when combined with an
ACE-inhibitor. An increase in dosing was associ-
ated with more numerous side effects. The present
study was designed to explore the relative efficacy of
12.5 and 6.25 mg of HCT in combination with cap-
topril (C).
Material and methods: For the study 25 patients with
mild hypertension were recruited. Their mean age
was 63 years (SD ± 13 years). After a four week
wash-out period and a dose finding phase of eight
weeks, eight patients were stabilised at a diastolic
pressure of <95 mmHg on C 50 mg + HCT 12.5 mg
and 17 on C 25 mg + HCT 12.5 mg. These doses of C
were continued throughout the study. The patients
were then divided in two groups, receiving 12.5 mg
or 6.25 mg of HCT for four weeks. The groups were
then crossed over and treated for a further four
weekperiod. Finally, placebo wasgivenfor HCTfor
four weeks.
Frá '’göngudeild fyrir háþrýsting á Landspítalanum, Háskóla
íslands, 2,Delta hf., 3,Sjúkrahúsi Reykjavíkur, Fossvogi.
Fyrirspurnir, bréfaskipti: Þóröur Harðarson, göngudeild fyrir
háþrýsting, Landspítalanum, 101 Reykjavík.
Lykilorð: Háþrýstingur, angíótensín ummyndunarblokkar,
tiasíö.
Results: Although the mean supine blood pressure
was lower on HCT 6.25 mg than placebo by 5/3
mmHg this difference was not significant. The pres-
sure fall on HCT 12.5 mg in comparison with place-
bo was significant (9/7 mmHg, p<0.02) and the
supine systolic blood pressure was similarly signi-
ficantly lower on HCT 12.5 mg than 6.25 mg
(p<0.02).
The mean serum-K was significantly reduced by
HCT 12.5 mg but only two patients had values below
3.5 mmol/1 and none below 3.0 mmol/1. No change
was observed in serum creatinine values. No signif-
icant increase was reported in side effects on HCT +
C in comparison with placebo + C.
Conclusion: This and our previous studies suggest an
optimal dose of HCT of approximately 12.5 mg. A
dose of 6.25 mg may not be without an antihyperten-
sive effect. However, such an effect is likely to be
modest.
Keywords: Hypertension, ACE-inhibitors, Thiazides.
Ágrip
Tilgangur: Við höfum áður sýnt fram á að í
meðferð vægs háþrýstings er lítið unnið við að
auka skammt hýdróklórtíasíðs umfram 12,5 mg
í samsetningu með angíótensín ummyndunar-
blokka. Stærri tíasíð skammtur hafði í för með
sér auknar hjáverkanir. Þessari rannsókn var
ætlað að bera saman áhrifamátt hýdróklórtía-
síðs í skömmtunum 12,5 og 6,25 mg í samsetn-
ingu með kaptópríli.
Efniviður og aðferðir: Til rannsóknar völd-
ust 25 sjúklingar með vægan háþrýsting. Með-
alaldur þeirra var 63 ár (staðalfrávik 13 ár).
Eftir fjórar vikur án lyfja vorú átta vikur notað-
ar til að finna hæfilegan skammt af kaptópríli
ásamt 12,5 mg af hýdróklórtíasíði. Átta sjúk-