Possible beneficial effects of amlodipine, lisinopril, and their Combination on lipid profile in hypertensive patients

Abstract

It is well known that monotherapy does not provide therapeutic response in all hypertensive. Some
patients show an excellent response, while in others there is a poor response. Combination
antihypertensive therapy is administered when blood pressure is inadequately controlled by
monotherapy to achieve a balanced and additive antihypertensive effect with minimum adverse effects.
Both angiotensin converting enzyme (ACE) inhibitors and dihydropyridine type of calcium antagonists
are well established and widely used in monotherapy. An understanding of differences in the
mechanism of action of these agents allows a logical approach for the use of these agents as a
combination therapy. This study was designed to evaluate the possible beneficial effects of long acting
calcium channel blocker, amlodipine and the long acting Angiotensin converting enzyme (ACE)
inhibitor, lisinopril given either alone or in combination in patients with essential hypertension on lipid
profile (LDL-C and HDL-C) and on other parameters using a randomized double blind, crossover
study. The study includes 150 patients with systolic blood pressure (SBP)>140 mmHg and diastolic
blood pressure (DBP) >90 mmHg received amlodipine 5 mg, lisinopril 5 mg and their combination
prior randomization schedule. Systolic, diastolic blood pressure and pulse rate were recorded at weekly
intervals while, serum levels of urea, creatinine, LDL-C and HDL-C where recorded at monthly
intervals, the duration of this study was 3 months. Results were obtained using paired students t-test,
differences were considered significant with (p<0.05).
A significant decline in SBP and DBP in all treatment groups (p<0.05) was recorded, the reduction
tend to be more pronounced in the combination group. Moreover, there was a significant effect of
combination on the heart rate, serum level of urea and creatinine, beside that, the level of HDL was
significantly elevated with amlodipine and combination. We concluded that combination had additional
blood pressure lowering effect when compared either with amlodipine or lisinopril alone, in addition to
the greater effect on lipid profile which demonstrated that this combination is potential
antiatherosclerotic agent.