Combination of Amlodipine and Enalapril in Hypertensive Patients with Coronary Disease

Background: Patients (pts) with stable coronary artery disease (CAD) can benefit from a decrease in the blood pressure (BP), according to recent studies. Objective: To evaluate the efficacy and tolerability of the fixed combination: amlodipine + enalapril, when compared to amlodipine in the normalization of the diastolic arterial pressure (DAP) (<= 85 mmHg), in pts with CAD and systemic arterial hypertension (SAH). Methods: Double-blind and randomized study, with two groups of pts with DAP >= 90 and < 110 mmHg and CAD. Patients with left ventricular ejection fraction (LVEF) < 40%, symptoms of heart failure or angina class III and IV, severe diseases and DAP >= 110 mmHg during the four-week wash-out with atenolol treatment alone, were excluded. After the wash-out, pts were randomly distributed for the use of the combination (A) or amlodipine (B) and were followed every four weeks up to 98 days. The initial doses (in mg) were, respectively: A-2.5/10 and B-2.5; the doses were increased when DAP > 85mmHg, at the visits. Statistical analysis was carried out with chi(2), Fischer and analysis of variance, for p<0.05. Results: Of the 110 selected pts, 72 (A=32, B=40) were randomized. The decreases in DAP and systolic arterial pressure (SAP) were significant (p<0.01), but with no difference between the groups in mmHg: SAP, A (127.7 +/- 13.4) and B (125.3 +/- 12.6) (p=0.45) and DAP, A (74.5 +/- 6.7 mmHg) and B (75.5 +/- 6.7 mmHg) (p=0.32). Group A presented a lower incidence of lower-limb edema: (7.1% vs 30.6%, p=0.02) on the 98th day of follow-up. Conclusion: The fixed combination of enalapril and amlodipine, as well as isolated amlodipine, was effective in the normalization of BP in pts with CAD and SAH stages I and II, adding blockage of the renin-angiotensin system. (Arq Bras Cardiol 2009; 92(3): 173-179)