Once‐Daily Lisinopril Compared with Twice‐Daily Captopril in the Treatment of Mild to Moderate Hypertension: Assessment of Office and Ambulatory Blood Pressures

Abstract

This multicenter, double-blind, parallel-group study compared the antihypertensive effects of two angiotensin-converting enzyme inhibitors, lisinopril and captopril, in 70 patients (35 lisinopril, 35 captopril) with mild-to-moderate essential hypertension. Doses of 10, 20, and 40 mg once-daily lisinopril or 25, 50, and 100 mg bid captopril were increased at biweekly intervals until patients responded to treatment, as defined by a decrease in office diastolic pressure to less than 90 mm Hg or at least a 10 mm Hg decrease from baseline. Patients who responded to a 2-week titration dose remained at that dose for another 2 weeks. Blood pressure assessments were made using both office and ambulatory blood pressure monitoring. Area under the curve analysis of ambulatory blood pressure reductions showed significant differences between treatment groups for both systolic (P = .023) and diastolic (P = .007) blood pressures, with lisinopril-treated patients showing the most significant reduction in pressure. Greater reductions (P less than .05) were also noted in patients receiving lisinopril at hours 10 to 12, suggesting two blood pressure troughs for those receiving captopril. Both drugs were well tolerated, and no patients withdrew from either treatment group. The authors concluded that after at least 4 weeks of therapy, once-daily lisinopril administration was more effective than twice-daily captopril administration in reducing blood pressure, when measured by 24-hour ambulatory blood pressure monitoring.

Trough to peak ratio of once-daily lisinopril and twice-daily captopril in patients with essential hypertension

“…However, office BP at the end of the treatment periods was lower, and the percentages of patients controlled according to the conventional criteria (office BP Ͻ140/90 mm Hg) and responders according the ABPM criteria were higher with lisinopril than with captopril. The results for lisinopril were similar to those reported by other investigators 6 and can be explained by the high trough effect of the dose of 20 mg of lisinopril 7 even administered once-a-day in comparison with 50 mg captopril after 12 h.…”

Differences between amlodipine and lisinopril in control of clinic and twenty-four hour ambulatory blood pressures

“…11,12 The reductions in supine SBP and DBP observed in lisinopril-treated patients (−7% for SBP and DBP) were less than those previously reported (between −10% and −12%) using doses between 10 and 20 mg once daily. 7,13 The results of the present study are similar to those from a preliminary report comparing amlodipine with lisinopril; 14 both drugs significantly reduced office BP in a group of 40 hypertensive patients (P Ͻ 0.005) although, in this case, the difference between the two drugs was not significant. The peak/trough ratio for effects on BP has been shown to be greater for amlodipine than for lispinopril over a 24-h dosing interval; 15 it is possible, therefore, that the significantly greater effect on clinic BP seen during amlodipine treatment in the present study may reflect an intrinsically longer duration of action of amlodipine compared with lisinopril.…”

“…2 It has been suggested that the greater the diurnal variation in BP, the greater is the target-organ damage; 3 those who fail to exhibit a nocturnal decrease in BP ('non-dippers') may have a greater risk of target-organ damage than 'dippers'. 4,5 Once-daily amlodipine and lisinopril have both been demonstrated to produce satisfactory control of clinic BP 6,7 and 24-h BP. 8,9 The present study was designed to compare the efficacy of amlodipine and lisinopril in terms of clinic and 24-h BP control.…”

Ambulatory blood pressure monitoring and 24-h blood pressure control as predictors of outcome in treated hypertensive patients

“…60,61 Over-treatment during the sleeping hours may be hazardous, particularly in patients with coronary or cerebral atherosclerosis. [62][63][64] Since clinic blood pressure, even at the end of the dosage interval, can be misleading, 41,65,66 the prognostic significance of 24-h blood pressure control, including night-time control, and attenuation of the early morning surge in blood pressure can only be tested in prospective controlled trials incorporating ABPM.…”