[Comparison of metabolic and hemodynamic effects of hydrochlorothiazide in monotherapy and in association with lisinopril. An Italian multicenter study].

The aim of this study was to evaluate the metabolic effects of the treatment with hydrochlorothiazide 25 mg/die monotherapy and with the association of lisinopril 20 mg + HCT2 12.5 mg/die in patients with mild to moderate arterial hypertension, in addition to antihypertensive efficacy and tolerability. For this aim 669 hypertensive patients have been randomized in a double blind, parallel study to the monotherapy or to the association. The follow-up was of 12 weeks, after a run-in wash-out period of 3-4 weeks. Seated blood pressure and heart rate were measured in all 4 outpatients visit and blood was withdrawn for serum electrolytes, glycemia, serum creatinine, uric acid and lipoprotein profile. 338 patients were randomized to the association and 331 to monotherapy with a slight prevalence of women. Mean age (58 +/- 9 and 56 +/- 10 years), pretreatment seated blood pressure (165 +/- 14/102 +/- 5 and 166 +/- 15/105 +/- 5 mmHg) and heart rate (77 +/- 9 heart/min in both group) were similar in the two groups. Seated blood pressure was significantly reduced in both groups (-22.8/-16.8 mmHg in the association group and -18.8/-13.4 mmHg in the monotherapy group), however the blood pressure reduction in patients treated with the association was slightly, but significantly, greater. Lipid profile, blood glucose, serum potassium and creatinine and uric acid were slightly worsened in the monotherapy group, while there were no changes or a mild improvement in patients treated with the combination of diuretic and the ACE-inhibitor. In conclusion the association lisinopril 20 mg+hydrochlorothiazide 12.5 mg/die causes a blood pressure reduction slightly, but significantly, greater than with a higher dose of the diuretic monotherapy, without any negative interference on lipid profile, blood glucose and serum potassium.