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

Rj, MacFadyen; Bainbridge, A. D.; Lees, KR; Reid, JL

doi:10.1111/j.1365-2125.1991.tb03918.x

Cited by 8 publications

(5 citation statements)

References 32 publications

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“…Systolic blood pressure, diastolic blood pressure, and heart rate were measured every 20 minutes from 7 AM to 11 PM (daytime) and every 30 minutes from 11 PM to 7 AM (nighttime) according to the recommendations of the German Hypertension ~e a~u e .~ Blood samples for determination of serum ACE activity were taken every 4 hours during the five periods of blood pressure monitoring. After both single-dose and subchronic administration of enalapril, additional blood samples (0, 1,2,3,4,6,8,10,12,14,16,20,24 hours after dosing; also 36 and 48 hours after dosing for subchronic administration) were collected for determination of the serum concentrations of enalapril and its active metabolite enalaprilat.…”

Section: Methodsmentioning

confidence: 99%

Cardiovascular effects, pharmacokinetics, and converting enzyme inhibition of enalapril after morning versus evening administration

Witte

Weisser

Neubeck

et al. 1993

Clin Pharmacol Ther

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The cardiovascular effects and pharmacokinetics of once-daily enalapril were studied after single-dose and subchronic treatment in eight patients with hypertension by use of ambulatory blood pressure monitoring. Enalapril, 10 mg, was given at either 7 AM or 7 PM in a randomized crossover design. In addition, inhibition of serum converting enzyme was studied. Subchronic treatment at 7 AM significantly reduced blood pressure during the day but was less effective at night. Subchronic dosing at 7 PM significantly further decreased nighttime blood pressure followed by a slow increase during the day, with no effect on elevated afternoon values. Peak concentrations of enalaprilat were found 3.5 hours (morning) and 5.6 hours (evening) after drug intake (p < 0.05), whereas peak effects occurred 7.4 hours (morning) and 12 hours (evening) after drug administration. In conclusion, 24-hour blood pressure profiles in patients with hypertension were significantly influenced by the time of enalapril dosing. Differences in effect profiles could not be attributed to similar changes in pharmacokinetics or to different time courses of angiotensin converting enzyme inhibition.

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Section: Methodsmentioning

confidence: 99%

Cardiovascular effects, pharmacokinetics, and converting enzyme inhibition of enalapril after morning versus evening administration

Witte

Weisser

Neubeck

et al. 1993

Clin Pharmacol Ther

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“…Although the profile of adverse events on α 1 ‐blockade with doxazosin differs somewhat from that of other antihypertensive drug classes, the frequency of adverse events overall, including those that are troublesome or severe, is broadly similar across drug classes 11 . Postural hypotension after ACE inhibitors 25 and calcium antagonists 26 is well recognised.…”

Section: Discussionmentioning

confidence: 99%

Doxazosin in Hypertension: Results of a General Practice Study in 4809 Patients

Langdon

Packard

1994

Int J Clinical Practice

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SUMMARY The safety and efficacy of the selective α1‐adrenoceptor antagonist doxazosin were evaluated in a 10‐week open, non‐comparative multicentre trial in 4809 hypertensive patients (sitting diastolic blood pressure 95–114 mmHg) in general practice. Multiple coronary risk factors were present in the study population (mean age 58.4 years, 1486 patients ≥65 years) on entry: mean blood pressure was 173/103 mmHg, 21% were cigarette smokers, and baseline blood cholesterol (mean 6.84 mmol/l) exceeded 6.5 mmol/l in 56% and 5.2 mmol/l in 88% of patients. In all, 4385 patients (91%) completed the study, including 89% of those ≥65 years. Blood pressure was controlled (diastolic BP ≤90 mmHg or a reduction ≥10 mmHg) in 81% of patients with a mean reduction of 21/15 mmHg and a mean final daily dose of 2.9 mg doxazosin. Adverse events were reported in 827 patients (17%), were severe in 72 (1.5%), and led to withdrawal in 269 patients (5.7%). Dizziness and related symptoms (6%; severe 1.1%), headache (3.8%) and fatigue (2.6%) were most frequent; dizziness led to study withdrawal in 1.3% of patients. Fainting or syncope occurred in 13 patients (0.3%). Differences in adverse event frequency between younger (<65) and older patients were small (dizziness: younger 5.1%, older 8.1%). Troublesome postural hypotension was uncommon as a clinical problem. Modest but statistically significant reductions occurred in blood total (4.09%) and LDL (5.13%) cholesterol. These results are in accord with those of controlled studies, and help confirm the suitability of doxazosin as part of a multiple risk factor approach to the management of hypertension.

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“…While the incidence of first dose hypotension following quinapril is increased with concomitant diuretic therapy, the overall incidence of this side effect with monotherapy is suggested to be low in comparison with captopril or enalapril in patients with hypertension [11]. In essential hypertension, the suggested maintenance dose of 20 mg quinapril was well tolerated and was not associated with excessive falls in blood pressure [12].…”

Section: Introductionmentioning

confidence: 99%

Haemodynamic response and pharmacokinetics after the first dose of quinapril in patients with congestive heart failure.

Squire

Lees

et al. 1994

Brit J Clinical Pharma

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1. Twenty‐four elderly patients with stable, chronic congestive heart failure, NYHA II‐IV, requiring addition of an ACE inhibitor to their existing therapy were randomised to receive double‐blind a single dose of quinapril 2.5 mg p.o. or matching placebo after 24‐48 h supervised diuretic withdrawal. 2. The effect of treatment on resting supine blood pressure, heart rate, plasma angiotensin converting enzyme (ACE) and circulating plasma renin activity was compared between groups over the first 24 h after dosing. The pharmacokinetic profiles of quinapril and the active metabolite quinaprilat were determined. 3. Compared with placebo, quinapril caused a statistically significant but modest fall in blood pressure from 3 to 10 h post dose. The maximum fall of 12 mm Hg (95% C.I. 5.4‐18.5) was seen at approximately 5 h. Circulating ACE activity was 40% inhibited within 1 h. Maximum ACE inhibition (83.6%, 95% C.I. 76.7‐90.5) was observed at 3 h. ACE remained 60% inhibited at 24 h post dose. tmax for quinapril was seen at 2.6 +/‐ 1.2 h. while tmax for quinaprilat was at 3.6, +/‐ 0.8 h. 4. Treatment with quinapril was associated with a significant rise in plasma renin activity (PRA) of 8.83 ng AI ml‐1 h‐1 (95% C.I. 0.30‐17.96) compared with placebo. 5. Compared with placebo, quinapril 2.5 mg inhibits plasma ACE by over 60% for 24 h and reduces blood pressure for at least 10 h in patients with stable, chronic congestive heart failure. The blood pressure fall, although moderate and well tolerated, is more sustained than previously described for quinapril in heart failure.

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

Cited by 8 publications

References 32 publications

Cardiovascular effects, pharmacokinetics, and converting enzyme inhibition of enalapril after morning versus evening administration

Cardiovascular effects, pharmacokinetics, and converting enzyme inhibition of enalapril after morning versus evening administration

Doxazosin in Hypertension: Results of a General Practice Study in 4809 Patients

Haemodynamic response and pharmacokinetics after the first dose of quinapril in patients with congestive heart failure.

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