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Duration of angiotensin-converting enzyme inhibition: implications for tolerability
1Medical Research Department, ICI Pharmaceuticals, Macclesfield, UK.
Insights
Lisinopril, enalapril, and captopril show similar safety profiles in hypertension treatment. These angiotensin-converting enzyme inhibitors do not increase side-effect risks, even in long-term use.
Area of Science:
- Pharmacology
- Clinical Trials
- Cardiovascular Medicine
Background:
- Hypertension management often involves angiotensin-converting enzyme (ACE) inhibitors.
- Comparative safety data for ACE inhibitors like lisinopril, enalapril, and captopril are crucial for clinical decision-making.
Purpose of the Study:
- To compare the incidence of adverse events and withdrawals among lisinopril, enalapril, and captopril in patients with hypertension.
- To assess the safety profiles of these ACE inhibitors across different patient demographics, including age.
Main Methods:
- A multinational clinical-trial program involving patients with hypertension.
- Comparative analysis of adverse events and treatment withdrawals between lisinopril and enalapril groups (n=318 vs. n=321).
- Comparative analysis of adverse events and treatment withdrawals between lisinopril and captopril groups (n=230 vs. n=235).
Main Results:
- The incidence of adverse events was similar for lisinopril versus enalapril (10.4% vs. 8.7%) and lisinopril versus captopril (11.7% vs. 11.9%).
- Withdrawal rates were comparable across all three drug groups, with no significant differences observed.
- The safety profiles were consistent across different age groups, and adverse events reflected known class-specific effects of ACE inhibitors.
Conclusions:
- Lisinopril, enalapril, and captopril demonstrate comparable safety profiles in the management of hypertension.
- Long-acting ACE inhibitors do not appear to confer additional side-effect risks.
- The study supports the use of these ACE inhibitors with similar safety expectations.
Abstract:
A large co-ordinated multinational clinical-trial programme in hypertension has provided comparative data on adverse events in patients on lisinopril (n = 318) compared with enalapril (n = 321) and in 230 patients on lisinopril versus captopril (n = 235). The three groups were demographically well matched with regard to age and duration of treatment. However, in comparison with the lisinopril group, the captopril-treated group had a slightly higher proportion of males (NS). The incidence of adverse events on lisinopril was similar to that on enalapril (10.4 vs. 8.7%, NS) and captopril (11.7 vs. 11.9%, NS). The incidence of withdrawals was similar on lisinopril and enalapril (1.9 vs. 1.9%, NS) and captopril (4.8 vs. 3.0%, NS). The most frequently reported events affected the digestive, respiratory, or nervous and psychiatric systems of the body. The pattern of events and withdrawals was similar for all three drugs. The incidence of laboratory changes for lisinopril versus enalapril and lisinopril versus captopril was similar. The safety profiles of all three drugs were comparable in young and elderly patients. First-dose hypotension was reported for 2 of 548 patients on lisinopril, and renal failure was reported for 3 of 286 patients on enalapril. Overall, the events reflected the class-specific effects previously identified for angiotensin-converting enzyme inhibitors. The data indicate that long-acting angiotensin-converting enzyme inhibitors do not impose any additional side-effect risk in hypertension.