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First‐dose hypotension after angiotensin‐converting enzyme (ACE) inhibitors in chronic heart failure: a comparison of enalapril and perindopril
Author(s) -
Vítovec Jirí,
Špinar Jindrich
Publication year - 2000
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1016/s1388-9842(00)00095-7
Subject(s) - enalapril , medicine , perindopril , heart failure , ace inhibitor , angiotensin converting enzyme , blood pressure , ejection fraction , cardiology , asymptomatic , dilated cardiomyopathy , captopril
Background: First‐dose hypotension refers to an observed reduction in blood pressure after the administration of the first dose of ACE inhibitors in patients with congestive heart failure. Aim: To compare the first‐dose responses of low‐dose enalapril and perindopril in patients with stable symptomatic chronic heart failure. Methods: Single blind, randomised, multicenter, parallel, prospective study. Patients ( N = 298) with chronic heart failure due to ischemic heart disease or dilated cardiomyopathy, NYHA II–IV, ejection fraction < 40%, age > 18 years, naive to ACE inhibitors or ATI‐receptor blocker, were randomised to receive a single dose of 2.5 mg enalapril or 2.0 mg perindopril. Baseline laboratory and clinical examinations were performed before entry into the study. Ambulatory blood pressure monitoring started 2 h before the study medication was given, and continued for at least 10 h after the medication. Results: The maximum drop in blood pressure appeared approximately 4 h after dose administration in both groups, and was more pronounced in the enalapril group. Patients in the enalapril group had a significantly higher incidence of asymptomatic hypotension. No symptomatic hypotension requiring a change in medication or a prolongation of hospitalisation was observed. Conclusion: A low dose of perindopril is well‐tolerated at initiation of ACE inhibitor therapy in patients with chronic heart failure and causes less first‐dose hypotension than a low dose of enalapril.