Safety and Efficacy of Enalapril Combined with Metoprolol in Patients of Hypertension Complicated with Coronary Heart Disease: A Randomised Clinical Trial

Abstract

Introduction: Enalapril, which inhibits Angiotensin-Converting Enzyme (ACE), is a commonly used drug for the treatment of hypertension. Metoprolol, a β-blocker, is widely prescribed for patients with cardiac diseases. Essential hypertension has been identified as an independent risk factor of Coronary Heart Disease (CHD). Until now, there are few studies and reports on the application of the two drugs in patients with Hypertension and Coronary Heart Disease (HCHD). Aim: To assess the safety and efficacy of enalapril combined with metoprolol in patients with HCHD. Materials and Methods: The present single-centre randomised clinical trial was conducted on 109 patients with HCHD at Jingdezhen Municipal First People’s Hospital from April 2018 to January 2020. The participants were randomly divided into into two groups, one group on enalapril (n=58), and the other on enalapril and metoprolol combination (n=51). Patients in both groups were treated for eight weeks. The blood pressure, cardiac function index, serum C-Reactive Protein (CRP), Homocysteine (Hcy), and Matrix Metalloproteinase-9 (MMP-9) levels were compared between the two groups, and the adverse drug reactions of the two groups were statistically analysed using independent sample t-test or Mann-Whitney U test. Results: The mean age of enalapril group was 64.78±7.29 years, and the gender ratio was 1:1.42. The mean age of enalapril/ metoprolol combination group was 63.90±6.91 years, and the gender ratio was 1:0.96. After treatment, both systolic and diastolic blood pressure of the enalapril/metoprolol combination group were significantly lower than that of enalapril group (p<0.05). Enalapril combined with metoprolol significantly improved cardiac function and significantly decreased the levels of serum inflammatory markers (CRP 18.57±3.61 vs 27.50±3.60, p<0.001; Hcy 12.14±2.07 vs 13.83±2.17 mmol L-1, p<0.001; MMP-9 372.35±12.34 vs 436.69±13.89 pg L-1, p<0.001; Transforming Growth Factor ALPHA (TGF-a) 8.18±1.38 vs 10.40±1.44 mmol L-1, p<0.001). The overall rate of adverse reactions was not significantly different between the groups (enalapril/metoprolol combination group vs enalapril group, 15.69% vs 10.34%, p=0.406). Conclusion: The combined treatment of enalapril and metoprolol was more effective than enalapril alone in reducing the inflammatory response, reducing blood pressure, and improving cardiac function in patients with HCHD. This combinational therapeutic strategy may be a better choice for patients with HCHD.