V G Garabedian | PubMed Health

PubMed1991

Lisinopril versus atenolol: decrease in systolic versus diastolic blood pressure with converting enzyme inhibition.

In a multicenter, parallel, double-blind study, lisinopril, a new converting enzyme inhibitor, was compared with atenolol in the treatment of mild to moderate essential hypertension. Four hundred ninety patients were randomized to once-a-day treatment with lisinopril 20 mg or atenolol 50 mg for 4 weeks, and the doses of lisinopril or atenolol were increased at 4-week intervals up to 80 mg or 200 mg, respectively, if sitting diastolic blood pressure (SDBP) was not well controlled. Lisinopril and atenolol reduced SDBP to a similar extent. All reductions from baseline in sitting diastolic and systolic blood pressure were significant (p less than 0.01). Lisinopril produced a significantly greater reduction (p less than 0.01) in sitting systolic blood pressure (SSBP) than atenolol. The predominant reduction in SSBP could not be explained on the basis of age, race, or severity of hypertension. It is suggested that the increase in arterial compliance reported for converting enzyme inhibitors could explain the predominant decrease in systolic blood pressure.

Adult↗

PubMed1985

[Conversion enzyme inhibitors in the treatment of chronic congestive cardiac failure. Physiopathologic bases of their use].

The treatment of chronic congestive heart failure relies on positive inotropic, diuretic, venous and arterial vasodilating drugs. Several factors are involved in the physiopathology of chronic congestive heart failure such as venous and arterial vasoconstriction mediated by the adrenergic system and/or the renin-angiotensin system which increases concomitantly the extracellular volume. These factors are initially compensatory of the low-cardiac output, but aggravate the heart failure on a long-term and are the basis for the use of vasodilating drugs and diuretics. Among vasodilating drugs the converting enzyme inhibitors are of special interest since they inhibit the renin-angiotensin system which is directly involved in the physiopathology of heart failure. On the other hand, they act both as venous and as arterial vasodilators and are generally better tolerated than pure venous or pure arterial vasodilating drugs. They are also better tolerated than the oral inotropic drugs commonly used (mainly digitalis) whose efficacy is controversial in patients being in sinus rhythm. The use of converting enzyme inhibitors, which is now restricted to the more severe cases of chronic heart failure, may be enlarged in the future to the first steps of heart failure, especially if a beneficial effect of these drugs on the long term survey may be proved.

Angiotensin-Converting Enzyme Inhibitors↗