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Effect of carvedilol, lisinopril and their combination on vascular and cardiac health in patients with borderline blood pressure: the DETECT Study

Journal of Human Hypertension volume 27, pages 362–367 (2013)Cite this article

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Abstract

Antihypertensive therapy is aimed at improving vascular and cardiac health, as well as lowering blood pressure (BP). The benefit of such drugs in untreated patients with borderline BP has not been demonstrated. Subjects with BPs ⩾130 mm Hg systolic or ⩾85 mm Hg diastolic and at least one additional risk factor were randomly assigned to treatment with carvedilol, lisinopril, their combination or placebo. Cardiovascular health was assessed by a disease score (DS), which combines the following tests of cardiovascular function and structure: resting BP, large- and small-artery elasticity (SAE), BP response to exercise, retinal vasculature analysis, electrocardiogram, carotid intima-medial thickness, left ventricular mass, microalbuminuria and N-terminal pro B-type natriuretic peptide. DS was assessed at baseline, after 3 and 9 months of therapy and 1 month after discontinuation of therapy. All active treatment groups displayed a sustained reduction in BP during 9 months of treatment, with the greatest reduction in the cardvedilol+lisinopril group. DS and SAE improved in all the treatment groups but the changes were of borderline significance and exhibited no evidence for progressive improvement from 3 months (functional) to 9 months (structural). All changes were reversed within 1 month after discontinuation of therapy. We conclude that 9 months of treatment with carvedilol, lisinopril or their combination produce a sustained and well-tolerated functional improvement but not a structural improvement, perhaps because of a lack of the nitric oxide-enhancing effects of other agents that inhibit structural changes in the vasculature.

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Acknowledgements

This work was supported by a research grant from GlaxoSmithKline.

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Authors and Affiliations

  1. Cardiology Division, University of Minnesota Medical School, Minneapolis, MN, USA

    S M Saul, D A Duprez & J N Cohn

  2. Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN, USA

    W Zhong & G A Grandits

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  1. S M Saul
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Correspondence to J N Cohn.

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Competing interests

Dr Duprez is member of speakers’ bureau of Merck, Novartis, Forest, Pfizer, Boehringer Ingelheim. He has received research grants from Novartis, Roche, Merck. Dr Cohn has received grant support from GlaxoSmithKline and Forest Research Institute. He is an equity partner in CVC-HD, LLC. The remaining authors declare no conflict of interest.

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Saul, S., Duprez, D., Zhong, W. et al. Effect of carvedilol, lisinopril and their combination on vascular and cardiac health in patients with borderline blood pressure: the DETECT Study. J Hum Hypertens 27, 362–367 (2013). https://doi.org/10.1038/jhh.2012.54

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