Step-down of enalapril treatment for arterial hypertension

Area of Science:

• Cardiology
• Pharmacology

Background:

• Essential hypertension is often associated with left ventricular (LV) hypertrophy.
• LV hypertrophy negatively impacts cardiac structure and function.
• QT dispersion is a marker of cardiac electrical instability.

Purpose of the Study:

• To evaluate the long-term effects of enalapril on blood pressure, LV mass, and QT dispersion in hypertensive patients.
• To determine if enalapril dosage can be reduced after achieving normalization of cardiovascular parameters.
• To assess the cardiovascular safety and cost-effectiveness of reduced enalapril dosage.

Main Methods:

• 24 patients with essential hypertension and LV hypertrophy received enalapril (20 mg BID).
• Treatment duration was 5 years, followed by stepwise dose reduction over the 8th year.
• Blood pressure, LV mass index, structure, systolic function, and QT dispersion were monitored throughout the study.

Main Results:

• Enalapril normalized blood pressure within 8 weeks.
• After 5 years, LV mass index decreased by 39%, normalizing LV structure and function.
• Dosage reduction up to 8-fold did not alter blood pressure, LV parameters, or QT dispersion.

Conclusions:

• Prolonged enalapril treatment normalizes blood pressure, LV structure, function, and QT dispersion in hypertensive patients.
• Significant dose reduction of enalapril is feasible without compromising cardiovascular control.
• Lower enalapril doses offer potential cost savings in managing hypertensive cardiovascular disease.