Possible beneficial effects of amlodipine, lisinopril, and their Combination on lipid profile in hypertensive patients

Abstract

It is well known that monotherapy does not provide therapeutic response in all hypertensive. Some patients show an excellent response, while in others there is a poor response. Combination antihypertensive therapy is administered when blood pressure is inadequately controlled by monotherapy to achieve a balanced and additive antihypertensive effect with minimum adverse effects. Both angiotensin converting enzyme (ACE) inhibitors and dihydropyridine type of calcium antagonists are well established and widely used in monotherapy. An understanding of differences in the mechanism of action of these agents allows a logical approach for the use of these agents as a combination therapy. This study was designed to evaluate the possible beneficial effects of long acting calcium channel blocker, amlodipine and the long acting Angiotensin converting enzyme (ACE) inhibitor, lisinopril given either alone or in combination in patients with essential hypertension on lipid profile (LDL-C and HDL-C) and on other parameters using a randomized double blind, crossover study. The study includes 150 patients with systolic blood pressure (SBP)>140 mmHg and diastolic blood pressure (DBP) >90 mmHg received amlodipine 5 mg, lisinopril 5 mg and their combination prior randomization schedule. Systolic, diastolic blood pressure and pulse rate were recorded at weekly intervals while, serum levels of urea, creatinine, LDL-C and HDL-C where recorded at monthly intervals, the duration of this study was 3 months. Results were obtained using paired students t-test, differences were considered significant with (p<0.05). A significant decline in SBP and DBP in all treatment groups (p<0.05) was recorded, the reduction tend to be more pronounced in the combination group. Moreover, there was a significant effect of combination on the heart rate, serum level of urea and creatinine, beside that, the level of HDL was significantly elevated with amlodipine and combination. We concluded that combination had additional blood pressure lowering effect when compared either with amlodipine or lisinopril alone, in addition to the greater effect on lipid profile which demonstrated that this combination is potential antiatherosclerotic agent.