Abstract
The efficacy and safety of the long-acting angiotensin converting enzyme(ACE) inhibitor cilazapril has been assessed in Saudi patients with mild to moderately severe uncomplicated essential hypertension, by comparing it with captopril in a randomised, double-blind, crossover study over an eight-week active treatment period on each drug. The dose schedule was 25mg of captopril b.i.d. at 2.5mg cilazapril once daily, doubled to 50mg b.i.d. and 5.0mg o.d. respectively at week 2 or later if there was no change in the sitting diastolic BP or a reduction of less than 10% was found. If doubling of the captopril or cilazapril dose failed to achieve a successful response, 25mg of hydrochlorothiazide and 50mg of triamterene daily were added to the treatment regimen.
Thirty patients (mean age of 46.8 (6.9) years) completed the trial. Diastolic blood pressure (BP) was taken as phase IV (muffling of Korotkoff sounds). Cilazapril generally produced more statistically significant reductions in systolic and diastolic BP as compared with captopril. Nine (30%) and three (10%) patients required doubling of the dose or the addition of diuretic during cilazapril administration. The corresponding figures for those patients receiving captopril were 15 (50%) and 10 (33%). With cilazapril, achievement of favourable BP control at eight weeks was 83% and 93% (using different response definitions) as compared with 63% and 77% with captopril. During therapy with both drugs, a statistically significant reduction in echocardiographically-determined left ventricular mass was achieved. Both ACE inhibitors had an acceptable safety profile.
We conclude that cilazapril is an effective ACE inhibitor for the management of Saudi patients with mild to moderately severe uncomplicated essential hypertension. Its long-acting effect would make its use a promising approach to minimise non-compliance.