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This was a double blind, parallel group, multicentre comparison of the therapeutic efficacy and acceptability of perindopril and captopril in essential hypertension. After one month of placebo, 165 patients with supine diastolic blood pressure (DBP) between 95 and 125 mmHg were randomised to perindopril 4 mg once daily or captopril 25 mg twice daily orally. The perindopril group (n = 82) had significantly higher pretreatment DBP (105.4 +/- 0.8 mmHg vs 102.3 +/- 0.6 mmHg) but other demographic variables were similar. Assessment was monthly for three months: 'uncontrolled' patients (DBP greater than 90 mmHg) had the dose doubled and then hydrochlorothiazide added. Two of the six withdrawals were attributed to drug side effects and were in the captopril group. There was no significant difference in the number of withdrawals or incidence of side effects between the drugs. The final titrated treatments were similar and monotherapy normalised DBP in 49% of each group. The final 'control' rate was higher with perindopril than captopril: 75% vs 57%, P = 0.016. The overall fall in DBP was greater in the perindopril group: 26.5 +/- 1.9 mmHg vs 18.9 +/- 1.9 mmHg, P = 0.005. The doses of diuretic were similar in the two groups. The DBP of patients who received only monotherapy for three months also fell more in the perindopril group (-17.5 +/- 1.4 mmHg vs -13.9 +/- 1.0 mmHg, P less than 0.01). At the doses studied, perindopril was more effective than captopril in lowering DBP, either as monotherapy or in combination with a diuretic.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of lisinopril 20 mg given once daily was assessed in 25 patients with mild to moderate essential hypertension using both ambulatory monitoring and cuff measurements of blood pressure (BP) made in the clinic. The effect of 4 weeks of lisinopril treatment on BP was compared with the BP recorded after 2 weeks on placebo. Lisinopril treatment reduced supine and standing cuff clinic measurements of BP 24 h after dosing by (systolic/diastolic) 21.1/11.8 and 16.7/10.1 mmHg, respectively. Ambulatory measurements indicated that the antihypertensive effect of lisinopril was sustained throughout the 24 h without any significant effect on heart rate and that lisinopril did not affect the diurnal rhythm of BP changes. Side effects reported during the 4 weeks of lisinopril treatment were mild and did not necessitate discontinuation of treatment. Lisinopril appears to be an effective and well-tolerated antihypertensive agent when given in a single daily dose.