A randomized, double-blind, placebo-controlled trial was conducted with 32 elderly patients (aged 75–97 years) with uncomplicated essential hypertension, to evaluate the efficacy and tolerance of enalapril, an angiotensin-converting enzyme inhibitor. It was given over an 8-week period in doses from 20 to 40 mg/day and was compared with an identical placebo. Enalapril caused a significant reduction in systolic blood pressure (SBP) and diastolic blood pressure (DBP) by the 2nd week, an effect that persisted through to the 8th week (190 ± 16/102 ± 7 to 151 ± 19/85 ± 11 mm Hg); 67% of patients had their pressures normalized ( < 160/95 mm Hg). BP was also significantly decreased by the 8th week under placebo (183 ± 16/101 ± 9 to 165 ± 21/91 ± 13 mm Hg), but only 35% of patients attained a normal pressure. Heart rate did not change with treatment. Enalapril caused an increase in plasma renin activity (1.22 ± 0.08 to 3.66 ± 2.50 ng/ml/h), whereas aldosterone levels remained unchanged. There was a mild, significant elevation of creatinine level with enalapril but other laboratory parameters, including serum potassium, were unaltered. Two deaths occurred in the enalapril group, but were not considered to be treatment-related. The drug was otherwise well tolerated. Serum enalapril concentration was assessed in 10 patients taking 20 mg/day over an 8-day period. At equilibrium, the level was 22.3 ± 5.0 ng/l and it correlated both with converting enzyme inhibition and with renal function. Enalapril is shown to be an effective and well-tolerated antihypertensive medication in elderly patients.

Keywords:
Enalapril, Angiotensin-converting enzyme inhibitor, Hypertension, Plasma renin activity
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© 1987 S. Karger AG, Basel
1987
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