A double-blind evaluation of moexipril versus hydrochlorothiazide in hypertension

Moexipril is the prodrug of a new long-acting nonpeptide, nonsulfhydryl angiotensin-converting enzyme (ACE) inhibitor. After once-daily oral administration, moexipril in doses of 7.5 mg, 15 mg, or 30 mg demonstrates potent and specific competitive inhibition of ACE. Maximum reductions in blood pressure are seen within 3 to 6 hours of administration, and the antihypertensive effect persists for up to 24 hours. Two hundred thirty-eight patients with mild to moderate hypertension entered a single-blind placebo period. Of these, 200 patients subsequently entered a double-blind parallel study comparing moexipril 7.5 mg and 15 mg, hydrochlorothiazide (HCTZ) 25 mg, and placebo once a day for 12 weeks. At the last predose measurement during the double-blind period, reductions in mean sitting diastolic blood pressure were 7.9 and 8.3 mm Hg with moexipril 7.5 mg and 15 mg, 3.1 mm Hg with placebo, and 8.8 mm Hg with HCTZ. Reductions were statistically significant at each 2-week measurement for all groups compared with placebo, except at week 10. Adverse effects were comparable in all drug groups and in the placebo group. in this double-blind study, the antihypertensive effect of both moexipril doses was comparable to that of HCTZ 25 mg daily. Moexipril 7.5 mg and 15 mg given once daily to patients with mild to moderate hypertension produced prompt, clinically important reductions in elevated blood pressure.