Thiazolidinedione therapy is safe and effective for ambulatory patients receiving hemodialysis. However, as we found that these drugs reduced systolic and diastolic blood pressure, further investigation into this drug effect is warranted.
Objective: To determine whether blood pressure could be maintained for patients on lisinopril following conversion to a theorized, therapeutic dose of fosinopril. The tolerability of fosinopril was also assessed. Methods: Subjects receiving lisinopril were considered candidates for this prospective, observational study. Prescribing information for both lisinopril and fosinopril suggested a milligram-to-milligram equivalency. Patients taking lisinopril 10 mg/d were switched to fosinopril 10 mg/d. Blood pressures were compared at baseline and 2, 6, and 18 weeks after conversion. A goal blood pressure of <140/90 mm Hg was assigned to all patients at enrollment and used to determine goal attainment at baseline and 18 weeks. More aggressive blood pressure goals are currently recommended; thus, medical histories were reevaluated at the end of the study and new goals were assigned and assessed. Adverse effect occurrence was also compared between visits. Results: One hundred thirty-three subjects were enrolled. The mean dose of lisinopril prior to conversion was 15 ± 11 mg/d compared with the mean final fosinopril dose of 20 ± 14 mg/d. Both the mean systolic and diastolic blood pressures increased significantly at the 18-week visit when compared with baseline (p = 0.00007 and p = 0.015, respectively). Using a goal blood pressure of <140/90 mm Hg, there was no difference detected between the baseline and the final assessment visit (p = 0.851). A greater number of subjects were unable to achieve goal status at 18 weeks when compared with baseline after applying the newly defined goals (p = 0.003). Sixteen of the original 133 subjects discontinued fosinopril due to adverse events. Conclusions: When converting subjects from lisinopril to fosinopril, equivalent blood pressure may be difficult to achieve without increasing the dose of fosinopril.
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