Lisinopril in Elderly Patients with Hypertension

Laher, M; Natin, D; Rao, Satya; Jones, Roy; Carr, P.

doi:10.1097/00005344-198700003-00017

Cited by 21 publications

(2 citation statements)

References 38 publications

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“…and the effect is not diminished with increasing age. This finding confirms earlier reports on the efficacy of ACE inhibitors in the elderly [6][7][8][9] and supports the view that the mode of action of such agents in the long term control of BP is not exclusively related to an effect on the circulating renin-angiotensin system.…”

Section: Discussionsupporting

confidence: 91%

Influence of Age on Blood Pressure Response to Enalapril

Cooper¹,

Glover²,

Kimber³

1987

Gerontology

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Based on prevailing hypotheses about the role of renin in essential hypertension, both Laragh and Buhler independently predicted that angiotensin-converting enzyme (ACE) inhibitors would become less effective with increasing age, as elderly hypertensive patients tend to have low plasma renin activity. We have investigated this situation in a large postmarketing surveillance study with enalapril. Following a 2-week no-treatment period, a total of 11,710 patients with essential hypertension received 10–20 mg of enalapril once daily for 6 weeks. BP was measured on two occasions prior to enalapril treatment, and on two occasions during enalapril treatment (after 2 and 6 weeks). Enquiry for symptom events was also made on each of these four occasions. Systolic BP (SBP) prior to enalapril treatment rose steeply with increasing age, whereas diastolic BP (DBP) rose only very slightly with age and reached a plateau by the 5th decade. The fall in SBP in response to enalapril increased with increasing age, but DBP was relatively uninfluenced by age. However, when corrected for initial BP, the percentage changes in both SBP (13%) and DBP (14%) were not different across the age range studied. Prior to receiving enalapril, 67.8% of patients were reporting symptoms, and this showed a positive correlation with age. During enalapril therapy, the overall level of symptom events reported fell significantly in all age groups (35.0%) but more so in the elderly, such that at the end of the study no significant age-related difference was detected. In all age groups, more than half of the events reported during enalapril therapy were of an improvement in general well-being. This study further supports the view that, contrary to earlier predictions, ACE inhibitors are at least as effective in elderly hypertensive patients as in younger patients. This may also be accompanied by a significant reduction in the number of adverse events reported, particularly in the most elderly. As age and BP are both continuous variables and are related to each other, they must be considered as continuous variables in the assessment of treatment effects. To use arbitrary definitions for the elderly (e.g. > 60 years or > 65 years) will only serve to exaggerate age-related phenomena and may lead to inappropriate recommendations for drug use.

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Section: Discussionsupporting

confidence: 91%

Influence of Age on Blood Pressure Response to Enalapril

Cooper¹,

Glover²,

Kimber³

1987

Gerontology

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“…However, Dupont et al [184] have reported that lisinopril significantly increases renal blood flow (+ 16%). Renal vascular resistance is reduced ( -19% to -25%) [184,186] and urinary protein excretion remains unchanged [187].…”

Section: Enalaprilmentioning

confidence: 99%

Acute and chronic effects of angiotensin converting enzyme inhibitors on the essential hypertensive kidney

Reams

Bauer

1990

Cardiovasc Drug Ther

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The natural course of essential hypertensive renal disease is characterized by a slowly progressive impairment of renal function. Initially, the changes are functional and reversible; however, structural changes gradually occur, leading to hypertensive nephrosclerosis. Similarities exist between the early functional hemodynamic changes observed in the essential hypertensive kidney and the physiologic renal effects of angiotensin II. To the degree that the initial functional changes are the result of excessive endogenous production of angiotensin II, interruption of the integrity of this humoral system could be expected to reverse the pathophysiologic sequence of events leading to hypertensive nephrosclerosis. This review focuses on the pathophysiology of the essential hypertensive kidney, the intrarenal effects of angiotensin II, and the acute and chronic effects of angiotensin converting enzyme (ACE) inhibition therapy on the essential hypertensive kidney. The data reviewed suggest that ACE inhibition therapy does reverse the initial functional hemodynamic changes observed in the essential hypertensive kidney and may protect the glomerulus from hemodynamically mediated injury.

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Combination of Converting Enzyme Inhibitor With Diuretic for the Treatment of Hypertension

Townsend

Holland²

1990

Arch Intern Med

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Lisinopril in Elderly Patients with Hypertension

Cited by 21 publications

References 38 publications

Influence of Age on Blood Pressure Response to Enalapril

Influence of Age on Blood Pressure Response to Enalapril

Acute and chronic effects of angiotensin converting enzyme inhibitors on the essential hypertensive kidney

Combination of Converting Enzyme Inhibitor With Diuretic for the Treatment of Hypertension

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