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Hemodynamic and biochemical changes after chronic administration of cilazapril to hypertensive patients
N Lefkos1, A Efthimiadis, I Liatsis
12nd Department of Internal Medicine, Aristotelian University, Thessaloniki, Greece.
Insights
Cilazapril, an ACE inhibitor, effectively lowers blood pressure and reduces left ventricular mass in hypertensive patients. It also improves glucose regulation and lipid metabolism without adverse effects on renal function.
Area of Science:
- Cardiology
- Pharmacology
- Nephrology
Background:
- Essential hypertension management requires effective antihypertensive therapies.
- Angiotensin-Converting Enzyme (ACE) inhibitors are a cornerstone of hypertension treatment.
- Cilazapril is a novel ACE inhibitor distinguished by its lack of a sulfhydryl group.
Purpose of the Study:
- To evaluate the long-term effects of cilazapril on hemodynamic parameters in hypertensive patients.
- To assess cilazapril's impact on renal function, glucose tolerance, and lipid metabolism.
- To investigate cilazapril's influence on left ventricular structure and diastolic function.
Main Methods:
- A study involving 30 patients with mild to moderate essential hypertension.
- Monotherapy with cilazapril (5 mg/24 h) for 4.5 months.
- Evaluations included 24-hour ambulatory blood pressure monitoring, echocardiography, oral glucose tolerance tests, and biochemical analyses of renal and lipid profiles.
Main Results:
- Cilazapril demonstrated effective antihypertensive action without reflex tachycardia.
- Significant reduction in left ventricular mass index with improved diastolic function, but no change in ejection fraction.
- No significant adverse effects on renal function, lipid profile, or serum transaminases.
- Improved glucose regulation, decreased insulinogenic index, and increased 6-keto-PGF1 alpha/TXB2 ratio observed.
Conclusions:
- Long-term cilazapril monotherapy is effective in managing essential hypertension.
- Cilazapril favorably impacts cardiac structure and diastolic function.
- The drug exhibits a beneficial metabolic profile, improving glucose regulation and potentially influencing prostacyclin/thromboxane balance.
Abstract:
The study describes the changes in basic hemodynamic parameters after long-term antihypertensive therapy with cilazapril--a new ACE inhibitor lacking a sulfhydryl group--in hypertensive patients and the drug effects on renal function, glucose tolerance and lipid metabolism. 30 patients (18 males, 12 females, mean age: 53.3 +/- 18 years) with mild to moderate essential hypertension were studied. The following determinations were performed in patients, before and after 4.5 months of cilazapril monotherapy at a dose of 5 mg/24 h: (a) antihypertensive action of the drug (arterial pressure at rest and during a 24-hour recording); drug effects on left ventricular (LV) mass index; its contractility indexes (%FS, EF) and the left atrial emptying index were studied by means of echocardiography; (b) plasma insulin concentration during oral glucose tolerance tests, in the fasting state, after the administration of 75 g glucose per os, as well as the changes in the insulinogenic index and the 6-keto-PGF1 alpha/TXB2 ratio, and (c) drug effect on renal function (urea, creatinine, uric acid, plasma electrolytes), blood lipid profile (total cholesterol, triglycerides, HDL-CH) and serum transaminases. Long-term drug administration exhibits an effective antihypertensive action, without causing reflex tachycardia and also reduces the LV mass index without affecting its EF, while improving its diastolic function. It does not significantly affect the various biochemical parameters, and achieves glucose regulation, both in the fasting state and after glucose loading, with a decrease in the insulinogenic index, and simultaneously increases the 6-keto-PGF1 alpha/TXB2 ratio. The existence of a direct cause-effect relationship between the changes in the above hormone systems is possible.