Additive effects of losartan and enalapril on blood pressure and plasma active renin
Azizi, M.; Guyene, T.T.; Chatellier, G.; Wargon, M.; Ménard, J.
Hypertension 29(2): 634-640
1997
ISSN/ISBN: 0194-911X PMID: 9040450 Document Number: 470245
The combination of single oral doses of an angiotensin I-converting enzyme inhibitor (captopril) and a type 1 angiotensin II receptor antagonist (losartan) has additive effects on blood pressure fall and renin release in sodium-depleted normotensive subjects. We planned the present study to determine whether the magnitude of the hemodynamic and hormonal consequences of renin-angiotensin system blockade by such a combination is larger than that obtained by doubling the dose of the angiotensin-converting enzyme inhibitor given alone. In a single-dose, double-blind, randomized, three-way crossover study, 10 mg enalapril, 20 mg enalapril, and the combination of 50 mg losartan and 10 mg enalapril were administered orally to 12 sodium-depleted normotensive subjects. The area under the time curve from 0 to 24 hours (AUC-0-24) of the mean blood pressure fall after losartan-enalapril combination intake (-220+-91 mm Hg cntdot h) was significantly greater than that of either 1 0 or 20 mg enalapril (-124 +- 91 and - 149+-85 mm Hg cntdot h, respectively; P lt .05 vs both doses). The combination significantly increased by 2.3 +- 1.2-fold the AUC-0-24 of plasma active renin compared with either 10 or 20 mg enalapril given alone (P lt .05) but had no additive effect on plasma aldosterone fall. The losartan-enalapril combination is more effective in decreasing blood pressure and increasing plasma active renin than doubling of the enalapril dose.