ACE inhibitors in the treatment of hypertension in the older patient

Abstract

Hypertension is a major potential problem among the increasing number of older persons in the population, threatening their health and shortening their life expectancy due particularly to stroke and congestive heart failure (CHF). Controlled studies have shown that antihypertensive drug therapy reduces the incidence of severe CHF, stroke and cardiovascular mortality in the elderly. Special consideration should be given to altered drug metabolism, altered responses to drugs, and concomitant medications when pharmacotherapy is instituted in the elderly. Angiotensin-converting enzyme (ACE) inhibitors are acceptable in the hypertensive older patient as first-line therapy for all grades of hypertension and as second-line therapy for the patient with CHF. Use of ACE inhibitors avoids many of the symptoms and metabolic disturbances associated with beta-blockers and diuretics. Quinapril is a new non-sulphydryl ACE inhibitor whose active metabolite, quinaprilat, has a relatively short accumulation half-life compared with enalapril and lisinopril but has an enhanced affinity for the converting enzyme, allowing rapid excretion of the drug while retaining a 24-hour antihypertensive effect with once-daily dosing. Quinapril is a valuable addition to the ACE inhibitor class, with demonstrated efficacy and safety in the older patient.

Amlodipine Added to Quinapril vs Quinapril Alone for the Treatment of Hypertension in Diabetes: The Amlodipine in Diabetes (ANDI) Trial

“…In addition, 6 patients (3.6%) in the highdose quinapril group and 2 patients (1.2%) in the combination quinapril/amlodipine group were withdrawn from the study because of an AE. In other studies, quinapril has been demonstrated to be similarly safe and well tolerated in patients with hypertension, 27,28 and additionally has been shown to preserve renal function in patients with diabetes. 29 A secondary outcome of the ANDI study was to evaluate the effect of quinapril alone compared with quinapril and amlodipine besylate in lowering hsCRP.…”

Secoisolariciresinol Diglucoside (SDG) Isolated from Flaxseed, an Alternative to ACE Inhibitors in the Treatment of Hypertension

“…ACE inhibitors have been used to reduce blood pressure in animal models [12][13][14] and human hypertension. [15][16][17][18][19] In conclusion, these results suggest that hypotensive effects of SDG isolated from flaxseed is mediated through inhibition of angiotensin-converting enzyme. SDG may prove to be an alternative to other ACE inhibitors for the treatment of hypertension.…”

A Multi‐Center Analysis of the Use of Enalapril and Lisinopril in Elderly Hypertensive Patients

“…A reasonable pathophysiologic approach to the pharmacologic treatment of hypertension in the elderly would call for a drug that lowers peripheral vascular resistance without further decreasing total blood volume and total body potassium. Even though the plasma renin activity may be suppressed, ACE inhibitors have been shown to be effective in the treatment of hypertension in elderly subjects 2 . Currently, there are seven ACE inhibitors on the US market.…”