Angiotensin-converting enzyme inhibitors evaluated by office and home blood pressure measurements: TeleHBPM study

Abstract

Background: Angiotensin-converting enzyme inhibitors (ACEI) are a class of drugs fundamental to hypertension treatment; however, the individual medications within this class vary in their effectiveness at controlling Blood Pressure (BP). Objectives: To analyze BP values obtained through casual measurements and home blood pressure monitoring (HBPM) in patients using ACEI as monotherapy or in dual combinations, focusing on BP control and goal achievement in a Brazilian population. Methods: A cross-sectional study evaluating adult patients using ACEI between 2017 and 2020 included in the TeleHBPM platform. SBP and diastolic blood pressure (DBP) values were assessed by casual and home measurements. Those using three or more HBPMs were excluded. Paired t-tests, chi-square tests, and ANOVA were used, with a significance level of 5% (p < 0.05). Results: 3,466 patients who met the criteria were selected, 54% in a dual drug combination. The mean BP values obtained via casual measurement and HBPM, respectively, were 131.6 ± 18.7 mmHg and 125.5 ± 14.8 mmHg for SBP (p < 0.001), and 83.4 ± 11.3 mmHg and 79.1 ± 9.4 mmHg for DBP (p < 0.001). The combination of ACEI with calcium channel antagonists prevailed (29%). Enalapril had similar BP means to ACEI with longer half-lives. Captopril monotherapy and in combinations had higher SBP and DBP means. Conclusion: Enalapril was the most commonly used ACEI, demonstrating a similar BP-lowering effect, both as monotherapy and in combination, when compared to other drugs in the same class with longer half-lives.