Lisinopril 20mg / Hydrochlorothiazide 12.5mg tablets

Background: Control of hypertension remains a critical global health challenge, particularly in lower to middle-income nations where access is constrained. This is complicated by the side effects associated with conventional antihypertensive medications and the preference towards natural remedies. Hibiscus sabdariffa (HS) is emerging as a non-pharmacological medicinal solution given its cardio-protective and antihypertensive effects. Objective To systematically review the evidence for the efficacy, side effects and interactions of Hibiscus sabdariffa in blood pressure management among hypertensive adults. Methods A comprehensive search of major databases (PubMed, Academia, ResearchGate, AJOL and Google Scholar) was conducted, identifying randomized controlled studies, systematic reviews and review articles published from January 2015 up till September 2024 that assessed the antihypertensive effects of Hibiscus sabdariffa. The review was registered in PROSPERO (PROSPERO2025CRD420251007414) and followed the PRISMA guidelines. The study considered hypertensive adults aged 18 to 64 years and HS was tested as monotherapy. Risk of bias was evaluated using Cochrane Handbook guidelines. Results From the 884 articles retrieved, 18 studies matched the inclusion criteria and were reviewed. HS was shown to decrease both systolic and diastolic blood pressure across different ethnic groups and population centres. HS was shown to have equivalent efficacy as standard antihypertensive agents in comparative studies such as with hydrochlorothiazide and lisinopril. Additional findings suggest HS may also have lipid-lowering, antidiabetic, and organ-protective effects. Minimum adverse effects were reported and safety profile was generally favourable. The potential for herb-drug interaction with diuretics was noted but remains insufficiently explored. Conclusion Hibiscus sabdariffa shows promise as an effective, safe, and affordable alternative or adjunct in the management of mild to moderate hypertension. There is, however, a need for more standardized trials to establish dosage, treatment duration, and interactions with conventional antihypertensive medications.

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ImportanceHypertension is a risk factor for the development and progression of chronic kidney disease (CKD). It is unclear whether different thiazide diuretics have a differential impact on kidney outcomes.ObjectiveTo compare kidney outcomes in patients with hypertension taking chlorthalidone and hydrochlorothiazide.Design, setting, and participantsThis prespecified secondary analysis of the Diuretic Comparison Project, a randomized clinical trial comparing chlorthalidone and hydrochlorothiazide for the treatment of hypertension, was conducted between June 1, 2016, and June 1, 2022, through Veterans Affairs facilities nationwide. This analysis extended follow-up to December 31, 2023. Veterans 65 years or older with hypertension who were taking hydrochlorothiazide were included.InterventionThe Diuretic Comparison Project randomized 13 523 participants to continue hydrochlorothiazide or switch to chlorthalidone.Main outcome and measuresThe main kidney outcome was CKD progression, defined as doubling of serum creatinine level from baseline, a terminal estimated glomerular filtration rate (eGFR) less than 15 mL/min, or dialysis initiation.ResultsAnalysis included 12 265 participants (90.7%) with a baseline and 1 or more follow-up creatinine measurements (median [IQR] age, 71 [69-75] years; 3.2% female and 96.8% male). The mean (SD) study duration was 3.9 (1.3) years. Chlorthalidone was not superior to hydrochlorothiazide at preventing kidney outcomes (369 of 6118 [6.0%] vs 396 of 6147 [6.4%]; hazard ratio [HR], 0.94; 95% CI, 0.81-1.08; P = .37). Similar results were observed when a 40% or greater reduction of eGFR was substituted for doubling of creatinine in the above outcome, as well as any of the components of the primary composite outcome. There was no difference in the incidence of CKD (961 of 4520 [21.3%] for chlorthalidone vs 939 of 4518 [20.8%] for hydrochlorothiazide; P = .59) or acute kidney injury requiring hospitalization (391 [6.4%] for chlorthalidone vs 379 [6.2%] for hydrochlorothiazide; P = .63) between groups. However, a statistically significant increased incidence of hypokalemia for chlorthalidone vs hydrochlorothiazide was observed (545 [8.9%] vs 426 [6.9%]; P Conclusions and relevanceChlorthalidone was not superior to hydrochlorothiazide for kidney outcomes but was associated with an increased risk for hypokalemia. Given these findings, clinicians should feel confident using either agent for the treatment of hypertension and kidney outcomes.Trial registrationClinicalTrials.gov Identifier: NCT02185417.

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Angiotensin-converting enzyme inhibitor (ACEI)-induced angioedema is an uncommon but potentially life-threatening adverse effect that can occur unpredictably, even after prolonged use. Prompt recognition and appropriate management are essential. We present the case of a 54-year-old Caucasian male with a history of ACEI-induced angioedema who developed isolated lingual swelling after re-exposure to lisinopril. His symptoms were unresponsive to antihistamines, corticosteroids, and epinephrine but resolved with supportive care following ACEI discontinuation. This case underscores the risk of recurrent angioedema following ACEI re-exposure and reinforces the recommendation for lifelong avoidance of ACEIs in patients with a prior diagnosis of ACEI-induced angioedema. Angiotensin receptor blockers (ARBs), which carry a lower risk of angioedema, may serve as preferred alternatives in high-risk patients. Patient education remains critical to preventing recurrence.

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