Lipid profile and antihypertensive efficacy in hyperlipidemic hypertensive patients: comparison of rilmenidine and captopril

Abstract

In hypertensive patients with lipid abnormalities, an ideal antihypertensive agent would control blood pressure without interfering with lipid metabolism. The aim of the present study was to assess whether in addition to angiotensin-converting enzyme inhibitors, calcium antagonists, and alpha 1-antagonists, rilmenidine (RIL), the first antihypertensive drug that is selective to imidazoline receptors, fulfills these requirements. To assess the effects of RIL (daily doses of 1 mg o.d. or b.i.d.) in comparison to captopril (CAP) (doses of 25 or 50 mg b.i.d.), an 8-week, double-blind, randomized, parallel-group study was carried out. Fifty-one patients (mean age: 56.3 +/- 1.5 years) with mild-to-moderate hypertension (supine systolic/diastolic blood pressure, 165.1 +/- 2.0/99.1 +/- 0.6 mm Hg) and type 2a or 2b hyperlipidemia (low-density lipoprotein (LDL) cholesterol: 5.38 +/- 0.16 mmol/L) were included in the study, and they were followed by their general practitioner at 4-week intervals. Twenty-six patients received RIL, and 25 received CAP. The permanence of hypercholesterolemia was checked twice before inclusion into the study, at 3-week intervals, for patients who had already been on a hypocholesterolemic diet for 6 weeks. Plasma lipid evaluation included total, LDL and high-density lipoprotein (HDL) cholesterol, triglycerides, apolipoproteins A1 and B, lipoprotein (a), and, last, a uric acid assay. Assays were centralized at the Lipid Laboratory, CHU Pitié-Salpétrière, Paris. In each group, 1 patient withdrew from the study for personal reasons, and four patients required a dose adjustment (double dose) at the week 4 visit. After 8 weeks of therapy, systolic blood pressure decreased significantly in both groups, with no statistically significant difference between groups (RIL, 20.5 mm Hg; CAP, 21.3 mm Hg; NS). Diastolic blood pressure also decreased (RIL, 13.9 mm Hg; CAP, 15.1 mm Hg; NS). No difference between groups was observed on the changes of lipid parameters between week 0 and week 8 visits. No severe adverse event occurred other than an asymptomatic atrial fibrillation in a CAP group patient at week 8. This study provides evidence that over a follow-up period of 8 weeks, both RIL and CAP are efficient and well-tolerated drugs in the first-line treatment of hypertensive patients with lipid abnormalities.