Metabolic and blood pressure effects of angiotensin converting enzyme inhibitors in mild-to-moderate American hypertensives.

To evaluate the effects of angiotensin converting enzyme (ACE) inhibition on metabolic effects as well as blood pressure, we studied 255 mild-to-moderate American essential hypertensives. After a 4-week placebo period subjects were randomly assigned to receive captopril (C) 25 mg tid, hydrochlorothiazide (H) 15 mg tid or both agents in combination (C j) tid. A significant (p less than 0.05) fall in blood pressure was seen in all three groups; C + H had a greater (p less than 0.05) than C or H. H was associated with a significant (p less than 0.05) fall in serum potassium and significant (p less than 0.05) increases in uric acid, glucose and cholesterol. With C alone no changes in these parameters were seen. With combination therapy (C + H) significant (p less than 0.05) blunting of diuretic-induced changes in potassium and uric acid and the significant increases in glucose and cholesterol seen with H were prevented. The side effects reported were mild with all regimens and rarely required discontinuation of therapy. The efficacy, safety and advantages of ACE inhibition make it attractive as primary treatment in mild-to-moderate hypertension.