Benazepril Hydrochloride/Hydrochlorothiazide

We investigated the blood pressure (BP) lowering efficacy of two dual antihypertensive therapies, the amlodipine/benazepril and benazepril/hydrochlorothiazide combinations, according to sodium sensitivity risk (SSR) as assessed by ambulatory BP monitoring (ABPM). In a multi-center, randomized, actively-controlled, parallel-group trial, patients with a clinic systolic/diastolic BP of 140 to 179/90 to 109 mmHg while on benazepril 10 mg daily monotherapy, received 24-week antihypertensive treatment with amlodipine/benazepril 5/10 mg (n = 213) or benazepril/hydrochlorothiazide 10/12.5 mg (n = 212). SSR was assessed with two 24-h ABPM parameters, BP dipper status at night and 24-h mean heart rate. The amlodipine/benazepril combination, compared with benazepril/hydrochlorothiazide combination, showed greater BP lowering effect in 304 patients with low/intermediate SSR, but smaller BP lowering effect in 121 patients with high SSR, with significant (P ≤ 0.046) interaction for 24-h, daytime and morning systolic BP. Indeed, in comparison with the benazepril/hydrochlorothiazide group, 24-h and daytime systolic BP reductions in the amlodipine/benazepril group were 4.19 and 5.17 mmHg, respectively, greater in patients with low/intermediate SSR, while morning systolic BP reductions was 10.8 mmHg smaller in patients with high SSR. Similar trends were observed for the other systolic BP measurements and diastolic BP measurements, although statistical significance was not attained (P ≥ 0.069). Sensitivity analysis in 367 patients with sustained hypertension was confirmatory. In conclusion, the antihypertensive treatment effect of the amlodipine/benazepril and benazepril/hydrochlorothiazide combinations was dependent on SSR as assessed by ABPM, with the former combination being more efficacious in patients with low/intermediate SSR, but less efficacious in patients with high SSR.