Quinapril hydrochloride effects on renal function in patients with renal dysfunction and hypertension: A drug-withdrawal study

Abstract

Patients with mild to moderate hypertension (diastolic blood pressure > or = 95 and < or = 115 mmHg) and renal dysfunction entered one of two studies to assess the safety of efficacious daily doses of quinapril on renal function and blood pressure. Twenty-four patients with moderate renal impairment (MRI) (creatinine clearance > 30 and < or = 60 ml/min) entered 24 weeks of open-label quinapril treatment; 31 patients with chronic renal failure (CRF) (creatinine clearance < 30 ml/min) entered 16 weeks of open-label quinapril treatment. Patients with MRI initially received quinapril 5 mg once daily (qd) followed by titration to a maximum dosage of 40 mg/day (furosemide optional at 40 mg only). Patients with CRF initially received quinapril 2.5 mg qd and were titrated up to 20 mg/day (furosemide optional). Open-label quinapril treatment resulted in significant decreases in mean systolic (SBP) and diastolic (DBP) blood pressure. The 20 patients with MRI and the 28 with CRF who completed the open-label phase were then randomly assigned to continue active drug or to receive placebo in a 4-week, double-blind, drug-withdrawal phase. During the double-blind withdrawal phase, placebo-treated patients had significant increases in mean SBP and DBP from the end of open label. Creatinine clearance was essentially unchanged following open-label quinapril treatment or quinapril withdrawal. In conclusion, in patients with mild to moderate hypertension and renal dysfunction, quinapril in dosages of 5-40 mg qd for patients with MRI and 2.5 to 20 mg qd for patients with CRF significantly reduces blood pressure without adversely affecting renal function.

Inhibition of angiotensin converting enzyme (ACE) by flavonoids isolated from Ailanthus excelsa (Roxb) (Simaroubaceae)

“…function (Miller et al, 1994). However, the side effects such as cough and angioneurotic edema associated with clinically used ACE inhibitors have been reported (Israili and Hall, 1992).…”

Angiotensin‐converting enzyme inhibitory and antioxidant activities of enzymatically synthesized phenolic and vitamin glycosides

“…It regulates the blood pressure by modulating the renin–angiotensin system [4]. The importance of ACE inhibitors in the chronic treatment of various cardiovascular diseases such as congestive heart failure [5], myocardial infarction [6], diabetic nephropathy [7] and renal dysfunction [8] is now well established. Several synthetic drugs such as enalapril, captopril, perindopril, ceranopril, ramipril, quinapril and fosinopril [9,10] and certain naturally occurring ‘biologically active peptides’ show ACE inhibitory activities [11,12].…”