Comparisons of long-term effects of lisinopril vs nifedipine vs conventional therapy in the treatment of mild-to-moderate hypertension in patients with chronic obstructive pulmonary disease

Abstract

Background: Any hypertensive patient may be found to have associated lung disease. The response of high blood pressure to specific antihypertensive agents in this category is still unknown. Thus, a group of 76 consecutive patients with mild-to-moderate hypertension and chronic obstructive pulmonary disease (COPD) were selected to participate in a clinical antihypertensive trial to define the roles of lisinopril, nifedipine and conventional therapy, and their impact on the renin-antiotensin system (RAS).

Methods: After a two-week placebo period, patients were randomly assigned to a regimen of one of three main treatment strategies: (A) lisinopril with or without diuretics; (B) nifedipine with or without diuretics; or (C) diuretics with or without conventional vasodilators (sorbitrate and hydralazine) or selective beta-blockers. The drug doses were titrated to a goal of less than 90 mmHg for maximal diastolic pressure, and the patients continued to receive therapy for at least one year.

Results: After one year of follow-up, only 66 patients had completed the study. All high blood pressure was significantly reduced by the three regimens (p < 0.005), but no significant difference in blood pressure control by any individual regimen was noted. Double product also showed the similar trend. Therapy A achieved the best reduction of double product among three regimens, but statis tieally insignificant. Furthermore therapy A suppressed the RAS, whereas therapies B and C might activate this system. Concomitantly, therapy A also had significant favorable effects on metabolic responses in contrast to therapy C. Therapy B revealed a neutral effect on such responses.

Conclusions: These data indicated that these three main strategies could provide significant antihypertensive efficacy for blood pressure control in patients with hypertension and COPD. For preventive strategy, therapy A may provide more advantageous effects than therapy C. A long-term double-blind trial including more subjects is warranted to identify the true advantages of therapy A in reduction or major cardiovascular and respiratory events.