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Angiotensin-Converting Enzyme Inhibitors and Diuretics: Optimal Combination Therapy
Barry R. Davis, MD, PhD;
Curt D. Furberg, MD, PhD;
Jackson T. Wright, Jr., MD, PhD;
Jeffrey A. Cutler, MD, MPH; and
Paul Whelton, MD, MSc
7 December 2004 | Volume 141 Issue 11 | Page 893
IN RESPONSE:
We thank Dr. Krantz for his thoughtful letter. The proposed strategy of using a diuretic and an ACE inhibitor simultaneously is supported by the effects of combined treatment in the Perindopril Protection Against Recurrent Stroke Study (PROGRESS) (1). However, that study could also be (and was) interpreted as showing that it's the blood pressure that matters, especially for stroke, and blood pressure reduction is much more effective with a diuretic in the regimen. Although the use of ACE inhibitors could in theory offset the metabolic effects (higher glucose and lower potassium levels) of thiazides, other potassium-sparing regimens may be just as or more effective, and a randomized trial to compare such regimens would be valuable. In addition, minimizing the metabolic effects would not necessarily translate into lower rates of important clinical outcomes, including coronary heart disease, stroke, and heart failure. Therefore, an events trial is also needed to test initiating treatment with different 2-drug combinations where 1 of the drugs is a thiazide diuretic.
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Author and Article Information
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From The University of Texas School of Public Health at Houston, Houston, TX 77030; Wake Forest University School of Medicine, Winston-Salem, NC 27157; Case Western Reserve University, Cleveland, OH 44106; National Heart, Lung, and Blood Institute, Bethesda, MD 20892; and Tulane University Health Sciences Center, New Orleans, LA 70112.
1. Chapman N, Huxley R, Anderson C, Bousser MG, Chalmers J, Colman S, et al. Effects of a perindopril-based blood pressure-lowering regimen on the risk of recurrent stroke according to stroke subtype and medical history: the PROGRESS Trial. Stroke. 2004;35:116-21. [PMID: 14671247].[Abstract/Free Full Text]
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Perspectives
ALLHAT: Setting the Record Straight
Barry R. Davis, Curt D. Furberg, Jackson T. Wright, Jr., Jeffrey A. Cutler, Paul Whelton, AND the ALLHAT Collaborative Research Group
- Annals 2004 141: 39-46.
[ABSTRACT][Full Text]
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