Double-blind study of ascending doses of ramipril in patients with mild to moderate hypertension

The antihypertensive effects of ascending doses of ramipril, a new nonsulfhydryl angiotensin converting enzyme inhibitor, were investigated in a multicenter, double-blind, placebo-controlled trial that included patients with mild to moderate essential hypertension. Following placebo washout, 216 patients were randomized to receive either placebo or ramipril 1.25, 2.5, 5, or 10 mg orally once daily for 12 weeks; of these, 213 were analyzed for efficacy. Compared with placebo, ramipril 2.5, 5, and 10 mg significantly reduced both supine and standing systolic and diastolic blood pressures at endpoint. The 1.25 mg dose was not significantly different compared with placebo. There was a trend between the magnitude of blood pressure reduction and increasing doses of ramipril. The minimum effective dose of ramipril was 2.5 mg. Ramipril was well tolerated; there was no significant difference in the incidence of side effects between ramipril and placebo at any dose level. The results indicate that ramipril at daily oral doses of 2.5, 5, and 10 mg is safe and effective in the treatment of mild to moderate essential hypertension.