To accomplish these goals, it is often necessary to use multiple drug therapies.[2–6] ACE inhibitors and ARBs are drugs with proven cardioprotective, renoprotective, and cerebroprotective properties. However, certain populations, like
African-Americans, are resistant to drugs that block the renin–angiotensin–aldosterone system [RAAS], like ACE inhibitors and ARBs given as monotherapy,[22,23] because these drugs exert their major antiPS-341 ic50 hypertensive effects through the blockade of 3-MA order RAAS, and Black patients are usually low-renin and volume-dependent hypertensive subjects. Several clinical trials have shown that the combination of ACE inhibitors with CCBs increases their Go6983 datasheet hypotensive potency[11–17,25]
because of a synergistic effect of inhibition of RAAS and a direct arterial dilatory effect, which is independent of RAAS inhibition. Most of the previous publications have used lower-dose ACE inhibitor–CCB combinations and did not specifically focus on the antihypertensive effects of these drug combinations on Black hypertensive patients compared with their White counterparts. In this report, we present our findings on low-dose amlodipine/benazepril 10/20 mg/day and high-dose amlodipine/benazepril 10/40 mg/day combination regimens for the treatment of Black and White hypertensive patients. Our results showed that the low-dose amlodipine/benazepril
combination resulted in significantly greater BP reductions and higher BP control and responder rates in White compared with Black click here hypertensive patients. In contrast, the high-dose amlodipine/benazepril combination eliminated this racial difference and resulted in similar reductions in BP control and responder rates. Other investigators have also reported that Black hypertensive patients treated with higher doses of ACE inhibitors show a greater BP response, compared with lower doses.[22,26–28] Combinations of CCBs and ACE inhibitors or ARBs have complimentary mechanisms of action that provide augmented efficacy, with reductions not only in BP but also in cardiovascular morbidity and mortality. The combination of amlodipine with perindopril in ASCOT (the Anglo-Scandinavian Cardiac Outcomes Trial) resulted in significant reductions in cardiovascular morbidity and mortality in high-risk hypertensive patients compared with an atenolol–diuretic combination, for similar reductions in BP. Also, in the ACCOMPLISH (Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension) study, patients treated with a combination of benazepril with amlodipine had a lower incidence of cardiovascular events than patients treated with a combination of benazepril with hydrochlorothiazide.