A Multicenter, Randomized, Double-Blind Comparison of the Efficacy and Safety of Irbesartan and Enalapril in Adults with Mild to Moderate Essential Hypertension, as Assessed by Ambulatory Blood Pressure Monitoring: The MAPAVEL Study

Background: When blood pressure (BP)-lowering efficacy is assessed by measurements taken in a clinic setting, angiotensin II-receptor antagonists show similar efftcacy to angiotensin-converting enzyme inhibitors and better tolerability. A search of MEDLINE to date, however, reveals no randomized, double-blind studies using ambulatory BP monitoring (ABPM) to compare the BP-lowering efficacy of irbesartan and enalapril in a large number of patients (>200) with essential hypertension. Objective: This study compared 24-hour BP reduction and BP control, as assessed by ABPM, in patients with mild to moderate essential hypertension treated with irbesartan or enalapril. The relative tolerability of the 2 treatments was also evaluated. Methods: This was a multicenter, randomized, double-blind study in patients with mild to moderate essential hypertension (office diastolic BP [DBP] 90-109 mm Hg or systolic BP [SBP] 140-179 mm Hg). After a 3-week, single-blind placebo washout phase, patients with a mean daytime DBP 285 mm Hg, as measured by ABPM between 10 AM and 8 PM, were randomized to 12 weeks of active treatment with irbesartan or enalapril. Starting doses were 150 and 10 mg/d, respectively, with titration to 300 or 20 mg/d if clinic DBP was 290 mm Hg at week 4 or 8. Based on clinic measurements, BP control was defined Presented as a poster at the 16th Scientific Meeting of the American Society of Hypertension, May 15-19, 2001, San Francisco, California. *The MAPAVEL Investigators are listed in the Acknowledgments. Accepted for publication October 31, 2001. Printed in the USA. Reproduction in whole or part is not permitted. 126 0 149-29 I 8/02/$19.00