A double-blind comparison between treatment effects of lisinopril and enalapril (10 mg every day) on the 24-hour blood pressure (BP) assessed by ambulatory noninvasive monitoring was performed in 40 patients, 20 randomized to enalapril and 20 to lisinopril. They had mild to moderate hypertension defined as a sitting diastolic BP >: 95 mm Hg and <115 mm Hg after 2 and 4 weeks on placebo following a washout period of 4 weeks. The mean 24-hour BP was lowered from 140/86 mm Hg on placebo to 132/81 mm Hg on enalapril and from 138/87 to 127/78 mm Hg after treatment for 4 weeks with lisinopril (NS for treatment differences). In 16 randomly chosen patients (8 on enalapril and 8 on lisinopril), additional 24-hour monitoring following a first dose of active treatment revealed more pronounced lowering of systolic BP 0-8 h after enalapril (p < 0.05). In these patients a reduced effect of enalapril and an improved effect of lisinopril was found after 4 weeks as compared with the first dose response (p <0.001 for systolic and p < 0.01 for diastolic BP). Repeated monitoring in 18 normotensive controls revealed an acceptable reproducibility of the 24-hour BP. Several problems exist with this method such as patient discomfort and a mean failure rate of 11 % (0-22) of all BP measurements, and there are currently no standards for which measurements to accept or reject. Although lisinopril may seem to have some advantages over enalapril, comparison by 24-hour BP monitoring would have needed a much larger population and more exact recordings to obtain firm conclusions.

Keywords:
Enalapril, Lisinopril, Moderate hypertension, Blood pressure monitoring (24 h)
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1991
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