Safety implications of combining ACE inhibitors with thiazides for the treatment of hypertensive patients.

Claudio Borghi, Mario Soldati, Alessio Bragagni, Arrigo F G Cicero

Expert opinion on drug safety 2020 Dec

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ACE-inhibitors (ACEI) and diuretics are the typical first-line antihypertensive drugs with complementary mechanisms of action. The present paper is summarizing the evidence supporting the efficacy of their combination in a broad range of hypertensive patients. This source of data is different trials investigating the use of ACEI and diuretics in different populations of patients. The available evidence supports some advantage for thiazide-type compounds (chlortalidone-CHT and indapamide-IND) in the prevention of major CV complications. In terms of safety, hydrochlorothiazide (HCTZ) and indapamide are associated with a lesser rate of hypokalemia and abnormalities of metabolic profile (glucose control, uric acid levels, serum potassium levels). As far as the results of clinical trials, the most relevant studies are involving the combination of benazepril or perindopril with HCTZ (benazepril) or IND (Perindopril) respectively. All these studies have resulted in a favorable clinical outcome. In terms of safety profile, the combination of ACEi and diuretic is safe and comparable with that of ACEi and calcium channel blockers with no differences in the rate of major adverse events (cough or angioedema) and a lower rate of ankle edema. The combination of ACEi and diuretic is safe and well-tolerated and should be considered among the first-line treatments in most of the patients with hypertension.

Citation

Claudio Borghi, Mario Soldati, Alessio Bragagni, Arrigo F G Cicero. Safety implications of combining ACE inhibitors with thiazides for the treatment of hypertensive patients. Expert opinion on drug safety. 2020 Dec;19(12):1577-1583