Enalapril plus hydrochlorothiazide versus propranolol plus hydrochlorothiazide in patients with mild to moderate hypertension

We compared enalapril plus hydrochlorothiazide (HCTZ) once-daily therapy with propanolol plus HCTZ twice-daily therapy in 151 patients with mild to moderate hypertension. A four-week placebo baseline period was followed by a 12-week treatment period during which patients could be titrated from 10/25 to 40/100 mg of enalapril/HCTZ or from 80/50 to 320/100 mg of propranolol/HCTZ daily. Mean age was 52 years, 109 were men, 97 were white, and 121 had baseline supine diastolic blood pressure (SuDBP) 90 to 105 mmHg. At 12 weeks, enalapril/HCTZ lowered SuDBP 16.8 mmHg and propranolol/HCTZ lowered SuDBP 16.5 mmHg from baseline (p < 0.05 from baseline; NS between treatments). Of those patients who completed week 12, 55/63 (87%) with enalapril/HCTZ and 59/69 (86%) with propranolol/HCTZ had SuDBP ≤85 mmHg or ≥10 mmHg reduction from baseline. Adverse clinical experiences were similar in both groups except for asthenia 9% and paraesthesia 7% in the propanolol group compared with 1% and 0% in the enalapril group (p < 0.05). The enalapril/HCTZ regimen was associated with fewer thiazide-induced biochemical changes than the propranolol/HCTZ regimen. We conclude that enalapril and propranolol are equally effective in lowering blood pressure when combined with HCTZ, but that the enalapril combination has less adverse clinical symptoms and metabolic changes.