Long-term monotherapy with lisinopril in renovascular hypertension

Eleven patients (five women and six men), aged 24-60 years, were treated with the angiotensin-converting enzyme (ACE) inhibitor, lisinopril, with a once-daily dose as the only antihypertensive treatment. Renal artery stenosis was unilateral in eight patients and bilateral in the remaining three. Fibromuscular dysplasia was present in seven patients, and renal arteriosclerotic narrowing was present in the remaining four. All completed a 6-month treatment and went on to a long-term treatment program for a final 24 months, now completed by five patients. Mean pretreatment blood pressure, 187 +/- 19/112 +/- 5 mm Hg (systolic/diastolic; mean +/- SD), was reduced to 148/87 following the drug titration period (1 week), and the same antihypertensive control was maintained throughout the study. Plasma concentration of angiotensin II, aldosterone, and serum ACE activity were effectively reduced for at least 24 h following drug administration. Serum concentrations of lisinopril varied individually and rose in two patients with moderate renal failure. Renal function was well maintained, and control renography revealed no worsening of renal artery stenosis or renal function. The drug was well tolerated without side effects other than cough in one patient. We conclude that lisinopril monotherapy is highly effective in renovascular hypertension. Drug safety was demonstrated by the lack of serious side effects.