Why the study?
Do different ACE inhibitors cause varying degrees of first-dose hypotension in patients with congestive heart failure?
Do different ACE inhibitors cause varying degrees of first-dose hypotension in patients with congestive heart failure?
Perindopril 2 mg does not cause significant first-dose hypotension compared to placebo in patients with congestive heart failure, unlike captopril, enalapril, and lisinopril.
Perindopril may be preferred to limit first-dose hypotension in CHF; confirms differential acute BP effects among ACE inhibitors.
Despite their proven value in reducing morbidity and mortality in different grades of heart failure, angiotensin converting enzyme (ACE) inhibitors continue to be underused. One reason for this is clinicians' apprehension of first-dose hypotension. We conducted a double-blind, randomised, placebo-controlled parallel group study to investigate the effect of various ACE inhibitors on first-dose hypotension. Eighty unselected patients were randomised into five treatment groups: placebo, captopril 6.25 mg, enalapril 2.5 mg, perindopril 2 mg and lisinopril 2.5 mg. Blood pressure was measured at baseline, half hourly for two hours and hourly for three hours after drug treatment. The maximum drops in mean arterial pressure (in mmHg +/- SD) were placebo 5.89 +/- 2.65, perindopril 5.29 +/- 2.49, enalapril 13.28 +/- 3.31, lisinopril 15.04 +/- 5.74 and captopril 16.76 +/- 5.74 (all p < 0.05 vs placebo except for perindopril). Perindopril, unlike the other ACE inhibitors studied, did not produce first-dose hypotension following its initiation in patients with congestive heart failure.
No takes yet. Share an insight, caveat, or question.
Navookarasu et al. (1999) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: