Angiotensin-Converting Enzyme Inhibitors and Diuretics: Optimal Combination Therapy
Authors: Mori J. Krantz, Philip S. Mehler
Journal: Annals of Internal Medicine (2004)

Letters7 December 2004Angiotensin-Converting Enzyme Inhibitors and Diuretics: Optimal Combination TherapyMori J. Krantz, MD and Philip S. Mehler, MDMori J. Krantz, MDFrom Colorado Prevention Center, Denver, CO 80204.Search for more papers by this author and Philip S. Mehler, MDFrom Colorado Prevention Center, Denver, CO 80204.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-141-11-200412070-00028 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Davis and colleagues' insightful review of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) (1) concludes by raising 2 important questions: If thiazide diuretics are the first choice for antihypertensive therapy, then what class of drugs should be used next in a stepped-care treatment program? Should treatment begin with 2 drugs? I propose that angiotensin-converting enzyme (ACE) inhibitors should be selected next and initiated simultaneously with diuretics. In support of this strategy, a secondary stroke prevention trial demonstrated no clinical benefits with ACE inhibitor monotherapy but found that ACE inhibitors used in combination with ...References1. Davis BR, Furberg CD, Wright JT, Cutler JA, Whelton P. ALLHAT: setting the record straight. Ann Intern Med. 2004;141:39-46. [PMID: 15238369] LinkGoogle Scholar2. Combined therapy with indapamide and perindopril but not perindopril alone reduced the risk for recurrent stroke [Abstract]. ACP J Club. 2002 Mar-Apr;136:2. Abstract of: PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack. Lancet. 2001;358:1033-41. [PMID: 11589932] MedlineGoogle Scholar3. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289:2560-72. [PMID: 12748199] CrossrefMedlineGoogle Scholar4. Pepine CJ, Handberg EM, Cooper-DeHoff RM, Marks RG, Kowey P, Messerli FH, et al. A calcium antagonist vs a non-calcium antagonist hypertension treatment strategy for patients with coronary artery disease. The International Verapamil-Trandolapril Study (INVEST): a randomized, controlled trial. JAMA. 2003;290:2805-16. [PMID: 14657064] CrossrefMedlineGoogle Scholar5. Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med. 2000;342:145-53. [PMID: 10639539] CrossrefMedlineGoogle Scholar6. Prisant LM. Preventing type II diabetes mellitus. J Clin Pharmacol. 2004;44:406-13. [PMID: 15051749] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Colorado Prevention Center, Denver, CO 80204. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoALLHAT: Setting the Record Straight Barry R. Davis , Curt D. Furberg , Jackson T. Wright Jr. , Jeffrey A. Cutler , Paul Whelton , and Angiotensin-Converting Enzyme Inhibitors and Diuretics: Optimal Combination Therapy Barry R. Davis , Curt D. Furberg , Jackson T. Wright Jr. , Jeffrey A. Cutler , and Paul Whelton Metrics Cited ByBlood Pressure-Lowering Efficacy of Amiloride versus Enalapril as Add-On Drugs in Patients with Uncontrolled Blood Pressure Receiving Hydrochlorothiazide 7 December 2004Volume 141, Issue 11Page: 893KeywordsACE inhibitorsAngiotensin converting enzyme inhibitorAntihypertensive drug therapyAttentionBlood pressureDiureticsEnzyme replacement therapyPotassiumStrokeSystolic pressure ePublished: 7 December 2004 Issue Published: 7 December 2004 CopyrightCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...