SYMPATHOMETABOLIC PROFILE OF LERCANIDIPINE/ENALAPRIL COMBINATION TREATMENT IN OBESE HYPERTENSIVE PATIENTS: S2.2

Combination drug treatment should fulfill a number of major requirements. These include: blood pressure lowering properties greater for magnitude than single components; a tolerability profile at least comparable to single agents; properties favouring an increased treatment adherence and compliance; sympathomodulatory and cardioprotecive properties. This latter requirement is of particular relevance because sympathetic activation is a common feature of hypertensive state (particularly when associated with clinical conditions such as obesity which contributes to the disease progression and development of organ damage). The ACE-inhibitor/calcium antagonist combination shows a number of potential advantages, compared to other combinations. Whether these include sympatho-modulation, however, is still undefined. The present study evaluated in a group of 36 middle-aged obese hypertensive patients the effects of an 8 week enalapril 20 mg + lercanidipine 10 mg vs. enalapril, 20 mg + felodipine 5 mg administration on clinic blood pressure, heart rate and sympathetic activity, as assessed by plasma norepinephrine measurement (HPLC assay) and direct evaluation of efferent post-ganglionic muscle sympathetic nerve traffic. Measurements were performed before and after 8 weeks of treatment with each of the two combination regimens. The results show that, despite a greater antihypertensive efficacy, the combination enalapril/lercanidipine did not cause substantial changes in 3 markers of adrenergic activity, i.e. heart rate, plasma norepinephrine and sympathetic nerve traffic, at variance from what observed with felodipine/enalapril combination. These data provide evidence that enalapril 20 mg/lercanidipine 10 mg combination is effective in the treatment of obesity-related hypertension. They also show that the above mentioned therapeutic regimen, at variance with enalapril 20 mg/felodipine 5 mg combination, exerts sympathomodulatory effects with a beneficial impact on cardiovascular and cardiometabolic homeostatic control.