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Bottom Line:
The combination of amlodipine besylate/benazepril HCl given to patients with
stage 2 systolic hypertension resulted in significantly greater reductions
in blood pressure and pulse pressure than those seen with monotherapy and
was at least as well tolerated as the separate components. This data
supports the recommendation of the JNC 7 for the use of combination therapy
in patients with stage 2 hypertension.
Reference:
Efficacy of Combination Therapy for Systolic Blood Pressure in Patients With
Severe Systolic Hypertension: The Systolic Evaluation of Lotrel Efficacy and
Comparative Therapies (SELECT) Study.Neutel JM, Smith DH, Weber MA,
Schofield L, Purkayastha D, Gatlin M.J Clin Hypertens (Greenwich). 2005
Nov;7(11):641-6
Synopsis:
Systolic hypertension is predominant among patients over 50 years of age, is
a more important cardiovascular risk factor than diastolic blood pressure,
and is more difficult to control than diastolic blood pressure.
Consequently, the Seventh Report of the Joint National Committee on
Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC
7) recommends combination therapy as first-line treatment for patients with
stage 2 hypertension. In the Systolic Evaluation of Lotrel Efficacy and
Comparative Therapies (SELECT) study, 24-hour ambulatory blood pressure
monitoring was used to identify patients with systolic hypertension and to
determine the impact of 8 weeks of treatment with either amlodipine besylate/benazepril
HCl 5/20 mg combination therapy (n=149), amlodipine besylate 5 mg (n=146),
or benazepril HCl 20 mg (n=148). Combination therapy was significantly more
effective in reducing systolic blood pressure and pulse pressure than either
monotherapy (p<0.0001). Significantly greater percentages of patients in the
combination group compared with either monotherapy achieved blood pressure
control (p<0.0001). Adverse events were low in all three treatment arms,
with less peripheral edema in the combination group than in the amlodipine-treated
group. |