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. 1991 Sep;32(3):393–398. doi: 10.1111/j.1365-2125.1991.tb03918.x

The response to the first dose of an angiotensin converting enzyme inhibitor in uncomplicated hypertension--a placebo controlled study utilising ambulatory blood pressure recording.

R J MacFadyen 1, A D Bainbridge 1, K R Lees 1, J L Reid 1
PMCID: PMC1368537  PMID: 1777377

Abstract

1. The importance of total dose to the initial hypotensive response with an angiotensin converting enzyme inhibitor (quinapril) was assessed using a suggested 'maintenance' dose (20 mg) or matched placebo in a randomised double-blind study in patients with uncomplicated hypertension. 2. Thirty-two patients were recruited who were not on therapy or had not received diuretic therapy in their existing drug treatment in the preceding 4 weeks. Secondary causes of hypertension had previously been excluded and sustained clinic blood pressures of SBP greater than 160 mmHg and/or DBP greater than 90 mmHg were taken as indications for a trial of adjuvant or monotherapy with an ACE inhibitor. 3. After uneventful supervised therapy with quinapril in an open pilot study (n = 5) 27 patients entered a double-blind, randomised, crossover study of quinapril or placebo using ambulatory monitoring to assess BP response. 4. All patients remained asymptomatic and both therapy and monitoring were well tolerated. A smooth onset of antihypertensive effect was noted with an overall 24 h placebo corrected fall in systolic BP of 9.9 mmHg (7.2-12.6 95% CI) and diastolic BP of 6.4 mmHg (4.2-8.8) with no significant effect on heart rate. Individual placebo corrected maximal responses during the first 8 h following quinapril showed a wide range for both systolic (+1.56 to 44.0 mmHg) and diastolic (+2.3 to -35.6 mmHg) pressure. Larger falls tended to be associated with higher baseline pretreatment pressures but in no case did absolute systolic pressure fall below 100 mmHg during the first 8 h following administration of placebo or quinapril.(ABSTRACT TRUNCATED AT 250 WORDS)

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Selected References

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  1. Asmar R. G., Pannier B. M., Santoni J. P., Safar M. E. Angiotensin converting enzyme inhibition decreases systolic blood pressure more than diastolic pressure as shown by ambulatory blood pressure monitoring. J Hypertens Suppl. 1988 Dec;6(3):S79–S81. [PubMed] [Google Scholar]
  2. Belz G. G., Kirch W., Kleinbloesem C. H. Angiotensin-converting enzyme inhibitors. Relationship between pharmacodynamics and pharmacokinetics. Clin Pharmacokinet. 1988 Nov;15(5):295–318. doi: 10.2165/00003088-198815050-00003. [DOI] [PubMed] [Google Scholar]
  3. Bühler F. R. Antihypertensive treatment according to age, plasma renin and race. Drugs. 1988 May;35(5):495–503. doi: 10.2165/00003495-198835050-00001. [DOI] [PubMed] [Google Scholar]
  4. Cheung D. G., Gasster J. L., Weber M. A. Assessing duration of antihypertensive effects with whole-day blood pressure monitoring. Arch Intern Med. 1989 Sep;149(9):2021–2025. [PubMed] [Google Scholar]
  5. Cleland J. G., Dargie H. J., McAlpine H., Ball S. G., Morton J. J., Robertson J. I., Ford I. Severe hypotension after first dose of enalapril in heart failure. Br Med J (Clin Res Ed) 1985 Nov 9;291(6505):1309–1312. doi: 10.1136/bmj.291.6505.1309. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Coats A. J., Conway J., Somers V. K., Isea J. E., Sleight P. Ambulatory pressure monitoring in the assessment of antihypertensive therapy. Cardiovasc Drugs Ther. 1989 Jun;3 (Suppl 1):303–311. doi: 10.1007/BF00148475. [DOI] [PubMed] [Google Scholar]
  7. Derkx F. H., Tan-Tjiong H. L., Man in 't Veld A. J., Schalekamp M. P., Schalekamp M. A. Activation of inactive plasma renin by plasma and tissue kallikreins. Clin Sci (Lond) 1979 Oct;57(4):351–357. doi: 10.1042/cs0570351. [DOI] [PubMed] [Google Scholar]
  8. DiBianco R. Adverse reactions with angiotensin converting enzyme (ACE) inhibitors. Med Toxicol. 1986 Mar-Apr;1(2):122–141. doi: 10.1007/BF03259832. [DOI] [PubMed] [Google Scholar]
  9. Donnelly R., Meredith P. A., Elliott H. L. Pharmacokinetic-pharmacodynamic relationships of alpha-adrenoceptor antagonists. Clin Pharmacokinet. 1989 Oct;17(4):264–274. doi: 10.2165/00003088-198917040-00004. [DOI] [PubMed] [Google Scholar]
  10. Graettinger W. F., Lipson J. L., Klein R. C., Cheung D. G., Weber M. A. Comparison of antihypertensive therapies by noninvasive techniques. Chest. 1989 Jul;96(1):74–79. doi: 10.1378/chest.96.1.74. [DOI] [PubMed] [Google Scholar]
  11. Hodsman G. P., Isles C. G., Murray G. D., Usherwood T. P., Webb D. J., Robertson J. I. Factors related to first dose hypotensive effect of captopril: prediction and treatment. Br Med J (Clin Res Ed) 1983 Mar 12;286(6368):832–834. doi: 10.1136/bmj.286.6368.832. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. LaBarre T. R., O'Connell J. B., Gunnar R. M. Captopril therapy for severe CHF: hypotensive response in presence of markedly elevated PRA. Am Heart J. 1982 Feb;103(2):308–309. doi: 10.1016/0002-8703(82)90513-0. [DOI] [PubMed] [Google Scholar]
  13. Lacourcière Y., Provencher P. Comparative effects of zofenopril and hydrochlorothiazide on office and ambulatory blood pressures in mild to moderate essential hypertension. Br J Clin Pharmacol. 1989 Mar;27(3):371–376. doi: 10.1111/j.1365-2125.1989.tb05379.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Lantz P., Enghoff E., Hedlund A., Hägg A. Hemodynamic results of perorally administered converting enzyme inhibitors in congestive heart failure. Scand J Urol Nephrol Suppl. 1984;79:129–132. [PubMed] [Google Scholar]
  15. Laragh J. H. Nephron heterogeneity: clue to the pathogenesis of essential hypertension and effectiveness of angiotensin-converting enzyme inhibitor treatment. Am J Med. 1989 Dec 26;87(6B):2S–14S. doi: 10.1016/0002-9343(89)90084-3. [DOI] [PubMed] [Google Scholar]
  16. Maclean D. Quinapril: a double-blind, placebo-controlled trial in essential hypertension. Angiology. 1989 Apr;40(4 Pt 2):370–381. doi: 10.1177/000331978904000406. [DOI] [PubMed] [Google Scholar]
  17. Mark A. L. The Bezold-Jarisch reflex revisited: clinical implications of inhibitory reflexes originating in the heart. J Am Coll Cardiol. 1983 Jan;1(1):90–102. doi: 10.1016/s0735-1097(83)80014-x. [DOI] [PubMed] [Google Scholar]
  18. Mujais S. K., Fouad F. M., Textor S. C., Tarazi R. C., Bravo E. L., Hart N., Gifford R. W., Jr Transient renal dysfunction during initial inhibition of converting enzyme in congestive heart failure. Br Heart J. 1984 Jul;52(1):63–71. doi: 10.1136/hrt.52.1.63. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. O'Brien E., Cox J. P., Fitzgerald D. J., O'Malley K. Discrepancy between clinic and ambulatory blood pressure measurement in the evaluation of two antihypertensive agents. J Hum Hypertens. 1989 Aug;3(4):259–262. [PubMed] [Google Scholar]
  20. O'Brien E., Mee F., Atkins N., O'Malley K. Accuracy of the SpaceLabs 90207 determined by the British Hypertension Society protocol. J Hypertens. 1991 Jun;9(6):573–574. doi: 10.1097/00004872-199106000-00016. [DOI] [PubMed] [Google Scholar]
  21. O'Brien E., O'Malley K. Overdiagnosing hypertension. BMJ. 1988 Nov 12;297(6658):1211–1212. doi: 10.1136/bmj.297.6658.1211. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Rion F., Waeber B., Graf H. J., Jaussi A., Porchet M., Brunner H. R. Blood pressure response to antihypertensive therapy: ambulatory versus office blood pressure readings. J Hypertens. 1985 Apr;3(2):139–143. doi: 10.1097/00004872-198504000-00005. [DOI] [PubMed] [Google Scholar]
  23. Rubin P. C., Curzio J. L., Kelman A., Elliott H. L., Reid J. L. Preliminary experience with a hospital blood pressure follow up clinic with nurse practitioner assessment and microprocessor based data retrieval. Br Med J (Clin Res Ed) 1984 Sep 1;289(6444):537–539. doi: 10.1136/bmj.289.6444.537. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Sedman A. J., Posvar E. Clinical pharmacology of quinapril in healthy volunteers and in patients with hypertension and congestive heart failure. Angiology. 1989 Apr;40(4 Pt 2):360–369. doi: 10.1177/000331978904000405. [DOI] [PubMed] [Google Scholar]
  25. Semple P. F., Thorén P., Lever A. F. Vasovagal reactions to cardiovascular drugs: the first dose effect. J Hypertens. 1988 Aug;6(8):601–606. doi: 10.1097/00004872-198808000-00001. [DOI] [PubMed] [Google Scholar]
  26. Streitberg B., Meyer-Sabellek W., Baumgart P. Statistical analysis of circadian blood pressure recordings in controlled clinical trials. J Hypertens Suppl. 1989 May;7(3):S11–S17. [PubMed] [Google Scholar]
  27. Verdecchia P., Gatteschi C., Benemio G., Boldrini F., Guerrieri M., Porcellati C. Duration of the antihypertensive action of atenolol, enalapril and placebo: a randomized within-patient study using ambulatory blood pressure monitoring. Int J Clin Pharmacol Ther Toxicol. 1988 Nov;26(11):570–574. [PubMed] [Google Scholar]
  28. Weber M. A., Tonkon M. J., Klein R. C. Effect of antihypertensive therapy on the circadian blood pressure pattern. Am J Med. 1987 Jan 5;82(1A):50–52. doi: 10.1016/0002-9343(87)90144-6. [DOI] [PubMed] [Google Scholar]
  29. White W. B., Morganroth J. Usefulness of ambulatory monitoring of blood pressure in assessing antihypertensive therapy. Am J Cardiol. 1989 Jan 1;63(1):94–98. doi: 10.1016/0002-9149(89)91083-7. [DOI] [PubMed] [Google Scholar]
  30. Williams G. H. Converting-enzyme inhibitors in the treatment of hypertension. N Engl J Med. 1988 Dec 8;319(23):1517–1525. doi: 10.1056/NEJM198812083192305. [DOI] [PubMed] [Google Scholar]

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