Amlodipine-Benazepril Therapy for Blood Pressure Variability and Prognosis in Elderly Patients with Postprandial Hypotension

Summary

This study aimed to evaluate the effects of amlodipine-benazepril combination therapy on blood pressure variability, vascular and renal function, and clinical outcomes in elderly patients with hypertension and postprandial hypotension.

Abstract

Postprandial hypotension (PPH), a common but underdiagnosed condition in elderly hypertensive patients, is associated with increased cardiovascular risk and mortality. Blood pressure variability (BPV), another independent prognostic factor, is often exacerbated in this population due to impaired autonomic function. This single-center retrospective study evaluated the effects of amlodipine-benazepril combination therapy compared with monotherapy in 150 patients aged ≥65 years diagnosed with hypertension and PPH. Patients were assigned to three groups (amlodipine-benazepril, amlodipine, or benazepril), and outcomes included the incidence of PPH after 4 weeks, 24 h ambulatory BPV at 6 months, changes in carotid intima-media thickness (cIMT), Crouse plaque score, renal function, left ventricular mass index (LVMI), and major adverse cardiovascular events (MACE) over 12 months. The combination therapy group demonstrated a lower incidence of PPH, greater reductions in BPV, improved vascular and renal parameters, and fewer MACE compared with either monotherapy group. No severe adverse events were reported. These findings provide preliminary evidence that amlodipine-benazepril combination therapy may enhance hemodynamic stability and organ protection in elderly patients with PPH. However, given the retrospective, single-center design, the results should be interpreted with caution, and larger prospective studies are warranted.

Introduction

Hypertension remains a major global health burden and a leading cause of cardiovascular disease and mortality, particularly in the elderly population¹. With increasing age, the prevalence of hypertension escalates, often coexisting with age-related syndromes such as postprandial hypotension (PPH)². PPH is defined as a decline of ≥20 mmHg in systolic blood pressure (SBP) within two hours after a meal, or a drop to <90 mmHg in those with premeal SBP ≥ 100 mmHg, often accompanied by symptoms such as dizziness, syncope, or visual disturbances³. It has important clinical consequences, i....

Protocol

This study was a retrospective, non-interventional analysis involving no prospective patient enrollment or biological sampling. In accordance with institutional guidelines for retrospective medical record research, the ethics committee of Beilun District People's Hospital formally waived the requirement for ethical approval and informed consent. All procedures were conducted following the Declaration of Helsinki (2013 version).

Study design overview
This was a single-center, retrospective cohort study evaluating the effects of amlodipine-benazepril combination therapy versus monotherapy in elderly patients with hy....

Results

Baseline characteristics
A total of 150 elderly hypertensive patients with PPH were enrolled and randomly assigned to three treatment groups (Figure 1): amlodipine-benazepril group (n = 50), amlodipine group (n = 50), and benazepril group (n = 50). Baseline demographic and clinical characteristics were well balanced across groups, with no statistically significant differences (all P > 0.05, Table 1). In addition to demographic features, basel.......

Discussion

This retrospective cohort study proposes a novel therapeutic strategy using amlodipine-benazepril combination therapy to manage BPV and PPH in elderly hypertensive patients (Figure 6). Our findings demonstrated that the fixed-dose combination significantly reduced the incidence of PPH after 4 weeks, lowered 24 h BPV at 6 months, and improved vascular, renal, and cardiac parameters more effectively than either monotherapy. Furthermore, the combination group showed a lower rate of MACE over 12.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
24 h ambulatory BP monitor	Schiller	BR-102 plus	ABPM with SD and circadian analysis; ABPM device; validated, calibrated quarterly
Amlodipine besylate tablets	Jiangsu Hengrui	H20000405	5 mg and 10 mg oral tablets
Benazepril hydrochloride tablets	Novartis Pharma	H20040289	10 mg and 20 mg oral tablets
Blood pressure monitor (automated)	Omron	HEM-7136	Validated oscillometric upper-arm model; validated oscillometric device; RRID: not available
Carotid ultrasound system	Mindray	DC-70	High-resolution B-mode scanner; linear array transducer, 7.5 MHz
Echocardiography machine	Philips	Affiniti 50	Used for LVMI and cardiac remodeling; phased-array transducer, used for LVMI/IVST
SPSS statistical software	IBM	SCR_002865	Version 23.0 for data analysis
Urine microalbumin test kit	Roche Diagnostics	6545225	Immunoturbidimetric assay