Comparative Haemodynamic Responses to the First Dose of Short- and Long-acting ACE Inhibitors in Patients with Congestive Heart Failure

Anthopoulos, Lambros; Αποστολου, Θωμασ; Bonoris, P.; Foussas, S.; Lefkos, N.; Zombolos, Spyros

doi:10.1185/030079901753403199

Cited by 11 publications

(4 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As concerns single molecules, data specifically referring to valsartan [ 61 ] and candesartan (OH incidence 0.2–0.8%) [ 62 ] do not report a clinically significant impact on orthostatic BP. Among ACE-I, OH risk seems to be higher for enalapril [ 63 ] and captopril, while it is lower for perindopril (incidence of hypotension 42% vs 15% for captopril and perindopril, respectively) [ 64 ].…”

Section: Antihypertensive Medications and Other Cardiovascular Drugs mentioning

confidence: 99%

Drug-Related Orthostatic Hypotension: Beyond Anti-Hypertensive Medications

et al. 2020

View full text Add to dashboard Cite

Orthostatic hypotension (OH) is an abnormal blood pressure response to standing, which is associated with an increased risk of adverse outcomes such as syncope, falls, cognitive impairment, and mortality. Medical therapy is one the most common causes of OH, since numerous cardiovascular and psychoactive medications may interfere with the blood pressure response to standing, leading to drug-related OH. Additionally, hypotensive medications frequently overlap with other OH risk factors (e.g., advanced age, neurogenic autonomic dysfunction, and comorbidities), thus increasing the risk of symptoms and complications. Consequently, a medication review is recommended as a first-line approach in the diagnostic and therapeutic work-up of OH, with a view to minimizing the risk of drug-related orthostatic blood pressure impairment. If symptoms persist after the review of hypotensive medications, despite adherence to non-pharmacological interventions, specific drug treatment for OH can be considered. In this narrative review we present an overview of drugs acting on the cardiovascular and central nervous system that may potentially impair the orthostatic blood pressure response and we provide practical suggestions that may be helpful to guide medical therapy optimization in patients with OH. In addition, we summarize the available strategies for drug treatment of OH in patients with persistent symptoms despite non-pharmacological interventions.

show abstract

Section: Antihypertensive Medications and Other Cardiovascular Drugs mentioning

confidence: 99%

Drug-Related Orthostatic Hypotension: Beyond Anti-Hypertensive Medications

et al. 2020

View full text Add to dashboard Cite

show abstract

“…The short half-life and rapid action of this drug are likely to be strongly linked to these events. On the other hand, ramipril and perindopril appear to be associated with a lower prevalence of orthostatic hypotension and hypotensive events [9,61,62,67,68].…”

Section: Ace Inhibitors and Angiotensin II Receptor Antagonistsmentioning

confidence: 99%

“…This may be partially explained by the protective action ACE-inhibitors exert on the kidney and by their final effect on blood pressure decrease. Considering the individual active principles, some studies show a correlation between the use of captopril and the onset of severe hypotensive events [61][62][63], first-dose orthostatic hypotension (estimated prevalence: 0,7-13,7% in general population and 2-33% in patients with heart failure) [64,65] and the presence of related symptoms [66]. The short half-life and rapid action of this drug are likely to be strongly linked to these events.…”

Section: Ace Inhibitors and Angiotensin II Receptor Antagonistsmentioning

confidence: 99%

Drugs and Orthostatic Hypotension: Evidence from Literature

Milazzo¹,

Stefano²,

Servo³

et al. 2012

J Hypertens Open Access

View full text Add to dashboard Cite

disease (PD): its prevalence ranges between 14% and 80% [12]. It is related to older age, severity and duration of the disease [13,14] and can be caused by autonomic dysfunction, drugs, or both causes. Few studies have evaluated the specific mechanisms of orthostatic hypotension in patients with PD. Lowering of blood pressure may be mainly due to drugs (in particular levodopa), when autonomic cardiovascular function tests are normal [15]. On the other hand, the absence of activation of compensatory chronotropic mechanisms to low blood pressure while standing may be due to autonomic failure [16]. Dopaminergic agonists (levodopa, carbidopa) frequently cause orthostatic hypotension, even at the beginning of therapy, through the activation of dopamine receptors, determining cutaneous, mesenteric and renal vasodilation, but also through other mechanisms, such as a reduced central sympathetic tone, which causes a small reduction in heart rate, and an impaired release of renin and aldosterone [17,18]. However, among antiparkinsonian drugs, selegiline seems to be more frequently involved in the onset of orthostatic hypotension, even after long-term therapy, if compared to levodopa [16,19]. Furthermore, while combined treatment with both drugs can determine severe orthostatic hypotension [20,21], levodopa alone is less often responsible for this phenomen. In fact, in additon to the peripheral vasodilatation due to dopamine agonists, the decreased reuptake of dopamine and norepinephrine in central neurvous system caused by selegiline causes a reduction in sympathetic tone [22]. Ha et al. [13] did not find a significant difference in dopaminergic agonist doses between PD patients with and without symptoms related to orthostatic hypotension, suggesting that other factors, such as age and other concomitant therapies, may be responsible for orthostatic hypotension in PD [13]. These data were further confirmed by Perez-Lloret et al.

show abstract

“…This is probably due to the slow onset of action of perindopril relative to other ACEIs (Table 5) [82][83][84][85][86][87].…”

Section: Safety and Tolerabilitymentioning

confidence: 99%

Perindopril: Beyond Lowering Blood Pressure

Zaiem

Zannad

2008

Future Cardiol.

View full text Add to dashboard Cite

Perindopril, a prodrug ester of perindoprilat, is an angiotensin-converting enzyme inhibitor that lowers angiotensin II and potentiates bradykinin. This agent has proven efficacy in a wide range of cardiovascular diseases. Its efficacy, safety and tolerability are well established in the treatment of hypertension. Beyond pharmacodynamic effects shown in lowering blood pressure, perindopril was also involved in the improvement of endothelial function and the normalization of vascular and cardiac structure and function. Large morbidity-mortality trials, such as the European Trial on Reduction of Cardiac Events with Perindopril in Patients with Stable Coronary Artery Disease (EUROPA), Perindopril Protection Against Recurrent Stroke Study (PROGRESS) and Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA), have shown that treatment with perindopril reduces and prevents cardiovascular disease in a large range of patients with vascular diseases (including stable coronary disease), whether or not they are hypertensive.

show abstract

Comparative Haemodynamic Responses to the First Dose of Short- and Long-acting ACE Inhibitors in Patients with Congestive Heart Failure

Abstract: Initiation of treatment with ACE inhibitors is associated with different haemodynamic and clinical tolerances in CHF patients, regardless of their risk for hypotension, with possible clinical implications.

Cited by 11 publications

References 31 publications

Drug-Related Orthostatic Hypotension: Beyond Anti-Hypertensive Medications

Drug-Related Orthostatic Hypotension: Beyond Anti-Hypertensive Medications

Drugs and Orthostatic Hypotension: Evidence from Literature

Perindopril: Beyond Lowering Blood Pressure

Contact Info

Product

Resources

About