Why the study?
Does the choice of specific ACE inhibitors reduce the incidence and severity of first-dose hypotension in patients with heart failure or myocardial infarction?
Does the choice of specific ACE inhibitors reduce the incidence and severity of first-dose hypotension in patients with heart failure or myocardial infarction?
Selecting ACE inhibitors with specific pharmacokinetic profiles, such as perindopril or fosinopril, can minimize the risk of first-dose hypotension in patients with heart failure or post-myocardial infarction.
Answers are grounded in this paper and cite their sources.
May favor perindopril or fosinopril to lessen first-dose hypotension in HF or post-MI; leaves open prospective RCT confirmation.
The first-dose induced decrease in blood pressure in some patients following the administration of ACE inhibitors is a fact causing some concern among clinicians prescribing these drugs. However, an overview of clinical trials and the authors' own experience clearly point to the possibility of reducing the incidence and/or severity of first-dose hypotension. Apart from appropriate clinical measures to be taken, the choice of the ACE inhibitor seems to be of crucial importance as some (fosinopril, perindopril) produce less hypotension than others. Thus, with due circumspection, ACE inhibitors can safely retain their position as the cornerstone of the treatment of chronic heart failure.
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Vítovec et al. (2004) conducted a review in Chronic heart failure and acute myocardial infarction. ACE inhibitors vs. Placebo or other ACE inhibitors was evaluated on First-dose hypotension.
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