Effects of benazepril alone and in combination with hydrochlorothiazide in comparison with felodipine extended release in elderly patients with mild- to-moderate essential hypertension

The aim of this study was to assess the efficacy and tolerability of two antihypertensive regimens-one using benazepril, eventually combined with hydrochlorothiazide in nonresponders, and the other using titration of felodipine extended release (ER)-in elderly patients with hypertension. After a 2-week washout period, 236 patients (127 men and 109 women aged 65 to 80 years) with mild-to-moderate essential hypertension (systolic blood pressure [SBP] ≤160 mm Hg and diastolic blood pressure [DBP] ≤95 mm Hg), were given benazepril 10 mg once daily (n = 118) or felodipine ER 5 mg once daily (n = 118) for 4 weeks, according to a multicenter, randomized, double-masked design. At the end of this treatment period, patients responding to treatment were kept at the same dose of their respective randomized drug for an additional 8 weeks. The nonresponders were given the fixed combination benazepril 10 mg plus hydrochlorothiazide 12.5 mg or felodipine ER 10 mg. Patients were examined at the end of the washout period and every 4 weeks thereafter. At each visit, sitting SBP and DBP were measured with a mercury sphygmomanometer and heart rate by radial pulse palpation. Adverse events were recorded. Both benazepril and felodipine ER were similarly effective in reducing SBP and DBP. No significant differences between the two treatment groups were observed in the mean decreases in blood pressure or in the number or percentage of patients with successful responses to treatment. Both treatments were well tolerated; the incidence of drug-related side effects, however, was slightly but significantly higher in the felodipine ER-treated group than in the benazepril group (14.4% vs 8.5%). In conclusion, benazepril 10 mg given as monotherapy, or as a fixed combination with hydrochlorothiazide in nonresponders, and felodipine ER 5 mg, titrated to 10 mg in nonresponders, were both effective and well tolerated in elderly patients with hypertension.