Enalapril 20mg / Hydrochlorothiazide 12.5mg tablets

Objectives: This systematic review and meta-analysis aimed to assess the blood pressure (BP)-lowering effect and the safety profile of low-dose bisoprolol/hydrochlorothiazide combination treatment in patients with hypertension. Methods: Multiple electronic databases were systematically searched, and five clinical studies were included in the meta-analysis. Results: Treatment with bisoprolol/hydrochlorothiazide significantly reduced systolic BP (SBP) [mean difference (MD): -8.35 mmHg, 95% confidence interval (CI): -11.44, -5.25 mmHg versus control; MD: -9.88 mmHg, 95%CI: -12.62, -7.14 mmHg versus placebo] and diastolic BP (DBP) [MD: -7.62 mmHg, 95%CI: -11.20, -4.04 mmHg, versus control; MD: -8.79 mmHg, 95%CI: -11.92, -5.67 mmHg versus placebo]. Moreover, BP response rate and BP control rate after low-dose bisoprolol/hydrochlorothiazide combination treatment were significantly greater compared to control [odd ratio (OR) for response rate: 4.86, 95%CI: 2.52, 9.37; OR for control rate: 1.67, 95%CI: 1.11, 2.51]. Finally, treatment with low-dose bisoprolol/hydrochlorothiazide was associated with a reduced risk of any adverse event (AE) and peripheral edema compared to control. Conclusions: Overall, our results reaffirm the safety and efficiency of prescribing bisoprolol/hydrochlorothiazide combination treatment in stage I and II hypertension.

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Cardiovascular conditions disrupt the normal functioning of the heart and blood vessels, often due to underlying conditions like atherosclerosis or hypertension. Antihypertensive medications are essential in cardiovascular disease management, encompassing several major drug classes with distinct mechanisms of action. Hence, this review evaluated the impact of various antihypertensive treatments on cardiovascular event reduction in asymptomatic carotid artery stenosis (CAS) patients. A comprehensive literature search was conducted from inception to 2024 on various databases by using specific keywords, and based on the eligibility criteria, three observational cohort studies and six randomized controlled trials (RCTs) of the 540 records retrieved were incorporated in this systematic review. The Newcastle-Ottawa scale was used to assess the methodological quality of the cohort studies, and the risk of bias visualization tool was used for RCTs. Data were then systematically extracted and analyzed. The results reported that enalapril and fosinopril demonstrated dual benefits in blood pressure (BP) reduction and vascular remodeling, though meta-analysis showed statistically insignificant improvements in regional cerebral blood flow (CI: -0.84, 6.08, P = 0.14, I2= 94%). Similarly, isradipine, lacidipine, and amlodipine improved carotid hemodynamics and cerebral perfusion, with meta-analysis favoring calcium channel blocker intervention for blood pressure management (CI: -3.25 to 7.64, P = 0.43). On the other hand, thiazide diuretics effectively reduced BP but showed limited efficacy in preventing atherosclerosis progression. In addition, angiotensin II receptor blockers (ARBs) significantly reduced 5-year stroke rates from 11% to 3.5%. Moreover, beta-blockers showed specific benefits, with metoprolol improving plaque echogenicity (57.3 ± 16.8 vs. 51.8 ± 20.0, p = 0.006) and reducing cardiovascular events (17% vs. 37% placebo, p = 0.011), while labetalol effectively managed post-endarterectomy hypertension. In conclusion, antihypertensive treatments showed varying effectiveness in cardiovascular event reduction and improvements in vessel measures.

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Abstract Objective: To assess the effectiveness and safety of management strategies for postpartum hypertension. Data sources: We searched the Cochrane Pregnancy and Childbirth’s Trials Register in collaboration with their Information Specialist, on 20/October/2022. As the Pregnancy and Childbirth Review Group closed (2023), we updated our literature search on 17/September/2024, using a strategy developed with an information specialist from the Royal College of Physicians, United Kingdom. Study eligibility criteria: We included randomised controlled trials (RCTs) assessing any intervention (pharmacological, surgical, or models of care) used to reduce maternal blood pressure (BP) in participants with postpartum hypertension. Study appraisal and synthesis methods: Search results were screened independently by two authors, with any disagreement resolved by consensus. Data were extracted independently, onto a Cochrane-based bespoke form which included Cochrane’s Trustworthiness Screening Tool. Random-effects meta-analysis was performed in RevMan. Results: Of 538 studies identified, 39 were included. Evidence was low/very low certainty. There were no safety concerns. In seven trials (n=1113 participants) of diuretics (primarily furosemide) vs. placebo/no therapy, BP control was better, due to trials administering antihypertensives to both groups. In three trials (n=96) of antihypertensive vs. placebo, data were insufficient to inform effectiveness. In eight trials (n=749) of antihypertensive (4 types) vs. another (2 types) for non-severe hypertension, additional antihypertensive need was similar in comparisons with either nifedipine or methyldopa, but greater when amlodipine or enalapril were compared with nifedipine. In eight trials (n=403) of antihypertensive vs. another for severe hypertension, BP was lower with diltiazem (vs. nifedipine). In four trials (n=668) of uterine curettage vs. usual care, small improvements in some laboratory parameters were of unclear clinical importance. In nine trials (n=1263) of models of postnatal care (usually BP self-monitoring/management, N=6) vs. usual care, BP was lower eight months postpartum following BP self-monitoring/management or lifestyle change. Conclusions: Diuretics cannot be recommended as monotherapy. There is little to guide choice of antihypertensive. Of greatest relevance to current practice is whether enalapril and amlodipine are as effective as nifedipine, and the role of BP self-measurement/management and lifestyle change in preventing longer-term cardiovascular outcomes.

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BackgroundIn patients with bone marrow transplantation (BMT) for hematologic malignancies, evidence for prevention of cancer therapy-related cardiac dysfunction (CTRCD) remains limited.ObjectivesThe authors investigated whether early initiation of sacubitril/valsartan or enalapril could be helpful to prevent CTRCD in patients undergoing BMT.MethodsWe randomized 90 patients with preserved left ventricular ejection fraction (LVEF) after BMT to sacubitril/valsartan, enalapril, or no cardioprotective medication (controls). The primary endpoints included i) LVEF, ii) LV global longitudinal strain (GLS), iii) myocardial wasted work (GWW), and work efficiency (GWE) by speckle tracking echocardiography. Secondary endpoints included changes in LV volumes.ResultsPatients treated with sacubitril/valsartan or enalapril for 6 months did not show a deterioration of LV GLS or LVEF (P > 0.05). Conversely, controls showed impaired LV GLS (-20.9% ± 2.1% vs -18.8% ± 2.6%, P = 0.001) and reduced LVEF (P = 0.045) at 6 months post-BMT. The percent improvement of GWW and GWE was greater in the sacubitril/valsartan compared to enalapril or control group (P = 0.044 and P = 0.011, respectively) at 6 months. Conversely, in controls, GWW increased (80.7 ± 60.6 vs 115.3 ± 52.1 mm Hg%, P = 0.045), and GWE was compromised (P = 0.030) at 6 months post-BMT. Among the 3 treatment groups, only sacubitril/valsartan group showed a reduction in LV end-diastolic and systolic volume compared to baseline (102.3 ± 26.9 vs 93.2 ± 18.9 mL, P = 0.042 and 44.5 ± 15.4 vs 39.1 ± 10.1 mL, P = 0.012, respectively).ConclusionsTreatment with sacubitril/valsartan or enalapril prevented deterioration of myocardial function at 6 months in patients with hematologic malignancies treated with BMT. Moreover, sacubitril/valsartan showed a more favorable effect on myocardial work indices. (Effect of Angiotensin Converting Enzyme and Sacubitril Valsartan in Patients After Bone Marrow Transplantation; NCT04092309).

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