Abstract

Background. ACE inhibitors are one of the leading class of drugs recommended for monotherapy or combined treatment of arterial hypertension. According to pharmacodynamic properties, lisinopril does not need liver metabolism for becoming an effective drug and it has an advantage in treatment of hypertensive patients with liver function impairment. Lisinopril has also been demonstrated to have a long term action. However, in most previous studies with lisinopril, 24-hour blood pressure monitoring as the best method to evaluate 24-hour antihypertensive effect was not used. The aim of the study was to evaluate the 24-hour antihypertensive efficacy of lisinopril (Diroton).

Methods. We studied 65 previously untreated patients (39 female and 26 male, mean age 57.7 years) with mild to moderate essential hypertension for 8 weeks in different hospitals in Estonia. Lisinopril (Diroton) was administered 10 mg once daily during 4 weeks. In patients with uncontrolled blood pressure, 20 mg of lisinopril was used for 4 more weeks. Patients with controlled blood pressure received 10 mg of lisinopril throughout the study. Outpatient 24-hour blood pressure monitoring with the use of ABPM-03 monitor (Meditech) was performed before and after 8-week treatment with lisinopril.

Results. Blood pressure decreased from 161.3/95.7 mm Hg to 142.3/84.5 mm Hg (p<0.01). Blood pressure control was achieved in 43 patients (66.2%). There was no significant change in heart rate during the study. Outpatient blood pressure monitoring demonstrated a  decrease in 24-hour systolic blood pressure by 9.6 mm Hg (p<0.05) and in diastolic blood pressure by 6.6 mm Hg (p<0.05). Despite the pronounced blood pressure lowering with lisinopril, normal diurnal variability was sustained. Diurnal index was unchanged after the 8-week treatment with lisinopril. Two patients reported cough. In one of them this side effect was severe and lisinopril was discontinued. No other significant side effects were reported.

Conclusions. Lisinopril (Diroton) treatment in patients with mild to moderate hypertension has pronounced 24-hour efficacy providing full 24-hour coverage. Lisinopril 10mg to 20 mg once daily was well tolerated. Very few side effects were recorded.