Lisinopril is a new, long-acting, nonsulfhydryl angiotension-converting enzyme (ACE) inhibitor that is excreted unchanged by the kidney. The antihypertensive efficacy and safety profiles of lisinopril were assessed in 24 patients (15 men, 9 women; mean age 52.3 years; range 21–75 years) with hypertension associated with impaired renal function (glomerular filtration rate GFR 60 ml/min or less), in an open study of 12 weeks’ duration. Previous antihypertensive drugs were discontinued at entry into the study. Lisinopril was given orally once daily; the starting dose was 2.5 mg in patients with a GFR of less than 30 ml/min, and 5 mg in all other patients. The dosage of lisinopril was titrated upward to 40 mg daily according to BP response. A diuretic could then be added if hypertension was inadequately controlled. Twenty-three patients completed the study. Mean sitting BP was reduced from 177 ± 21.2/106 ± 9.1 mm Hg (mean ± SD) at entry to the study to 145 ± 21.4/88 ± 8.3 mm Hg after 12 weeks of treatment (p < 0.001). The median dose of lisinopril used was 10 mg (range 2.5–40 mg) and only 4 patients had a diuretic added to the lisinopril. Overall GFR was unchanged during the study: mean baseline value was 37 ± 16.4 ml/min (range 10–60 ml/min) at the beginning of the study and 40 + 21.0 ml/min at the end. As in a previous pharmacokinetic study in similar patients, a tendency toward drug accumulation was noted only in those patients with the most severe renal impairment. One patient was withdrawn because of nausea and vomiting due to reflux esophagitis, which was probably not drug-related. Another patient had transient mild angioneurotic edema and continued on lisinopril. No clinically significant hematologic or biochemical changes were observed. Twelve patients were continued on lisinopril for a period of 1 year. BP was well maintained throughout, enabling a reduction in median drug dosage to 7.5 mg daily. Thus, in a group of patients who are often difficult to treat, lisinopril provided effective BP control and was well tolerated. Reduction of maintenance lisinopril dosage is suggested by follow-up observations over a period of 1 year.

Keywords:
Lisinopril, Impaired renal function, Hypertension
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© 1987 S. Karger AG, Basel
1987
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