מתוך medicontext.co.il
WESTPORT, CT (Reuters Health) – Results of a pilot study suggest that adding an angiotensin converting enzyme (ACE) inhibitor to antihypertensive treatment with calcium antagonists may be the most effective way to attenuate lower extremity edema.
Dr. Matthew R. Weir and colleagues at the University of Maryland School of Medicine, Baltimore, note that calcium antagonists "present a clinical challenge in that a sizable percentage of patients will develop the side effect of lower extremity edema."
To investigate the relative efficacy of thiazide diuretics and ACE inhibitors in combating this problem, the researchers conducted an open label study of 47 patients who, after a 4-week wash-out period, received antihypertensive therapy with oral amlodipine 5 mg/day. Altogether, 17 patients developed a 10% or greater increase in lower extremity edema water displacement over 6 weeks.
The subjects were then randomized to receive an additional 5 mg of amlodipine daily or 25 mg of hydrochlorothiazide or 20 mg of benazepril for another 6 weeks.
No net change in edema was seen in those who received additional amlodipine, but there was an edema reduction of 11.1% in the hydrochlorothiazide combination group and a 14.3% reduction in the benazepril combination group.
Furthermore, allowing for pretreatment values, blood pressure fell by 6.8 mm Hg in the amlodipine group, 9.9 mm Hg in the hydrochlorothiazide group and 26.2 mm Hg in the benazepril group.
The researchers, whose findings were published in the September issue of the American Journal of Hypertension, conclude that in such patients use of an ACE inhibitor "is the most effective way to not only reduce systolic and diastolic blood pressure but also attenuate lower extremity edema."
In an accompanying editorial, Dr. Franz H. Messerli of the Ochsner Clinic in New Orleans, observes that in another study, he and his colleagues also found that "adding an ACE inhibitor not only allows the vasodilatory edema to melt away but also further lowers arterial pressure."
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