Combined treatment of arterial hypertension (results of the international program CLIP-ACCORD)

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Aim. To investigate antihypertensive efficacy and safety of a fixed combination of ACE inhibitor enalapril with thiaside diuretic drug hydrochlorothiaside (HCT) in hypertensive patients with a high and very high risk of cardiovascular complications.
Material and methods. The trial has covered 7796 hypertensive patients from 28 cities (42 clinics) of Russia, Ukraine, Belarus and Georgia. All the patients had a high and very high risk of cardiovascular complications. The protocol provides for measurements of clinical arterial pressure, 24-h monitoring of arterial pressure. Diabetic patients' plasma was examined for glucose concentrations. All the patients received enalapril in combination with HCT in doses from 10/6.25 to 40/25 mg/day for 3 months.
Results. After 3 month treatment target systolic arterial pressure (SAP) was achieved in 81% patients, diastolic pressure (DAP) - in 88%, by SAP and DAP - 77%. By 24-h blood pressure monitoring, 24-h, diurnal and nocturnal blood pressure significantly decreased in 60 patients. Target 24-h blood pressure was achieved in 78% patients. Pressure load parameters lowered significantly for SAP and DAP for 24 hours, diurnal and nocturnal pressure. Glucose levels in patients with diabetes mellitus (n = 1263) diminished from 7.3 to 6.4 mmol/l (p < 0.0001).
Conclusion. A fixed combination of enalapril with HCT was effective in hypertensive patients with a high and a very high risk of cardiovascular complications. It provided a target level of blood pressure in 77% patients and significantly reduced SAP, DAP and PAD.


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