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Maintenance of blood pressure control and left ventricular performance with small doses of enalapril
J R González-Juanatey1, A P Reino, J M García-Acuña
1Cardiology Department, Complexo Hospitalario Universitario de Santiago de Compostela, Spain. jgonzalezd@meditex.es
Insights
Enalopril effectively normalized blood pressure (BP) and left ventricular (LV) hypertrophy in hypertensive patients. Lower enalapril doses maintained these benefits long-term, suggesting reduced dosages are sufficient for sustained cardiovascular health.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Essential hypertension is a leading cause of left ventricular (LV) hypertrophy.
- LV hypertrophy is associated with adverse cardiovascular outcomes and impaired cardiac function.
Purpose of the Study:
- To evaluate the long-term effects of enalapril on blood pressure (BP), LV structure, and function in patients with essential hypertension and LV hypertrophy.
- To determine if reduced enalapril dosages can maintain normalized cardiovascular parameters after prolonged treatment.
Main Methods:
- 24 patients with essential hypertension and LV hypertrophy received enalapril (20 mg BID) for 8 weeks, normalizing BP.
- Long-term follow-up (7 years) assessed changes in LV mass index, structure, systolic function, and QT dispersion.
- Dosage was stepwise reduced during the eighth year and maintained for one additional year.
Main Results:
- Enalapril normalized BP within 8 weeks.
- After 7 years, LV mass index decreased by 39%, with normalized LV structure, function, and QT dispersion.
- Stepwise enalapril dose reduction to 5 mg/day did not alter BP, LV parameters, or QT dispersion.
Conclusions:
- Prolonged enalapril treatment normalizes BP, LV structure, and function in hypertensive patients.
- Significantly smaller enalapril doses are sufficient to maintain these cardiovascular improvements long-term.
Abstract:
Enalopril treatment (20 mg every 12 hours) of 24 patients with essential hypertension and left ventricular (LV) hypertrophy established normal blood pressure (BP) after 8 weeks, and after 7 years had reduced LV mass index by 39% from 148 +/- 34 to 90 +/- 16 g/m2, and had normalized LV structure and function and QT dispersion. Stepwise reduction of the enalapril dosage from 40 to 30, 20, 10, and 5 mg/day during the eighth year caused no significant changes in BP, LV structure, LV systolic function, or QT dispersion, which all likewise remained unaltered during a further year of the 5-mg/day regimen. We conclude that for hypertensive patients in whom prolonged treatment with standard doses of enalapril has normalized BP, LV structure and function, and QT dispersion, significantly smaller doses are sufficient to maintain these cardiovascular achievements.