Angiotensin-converting enzyme (
ACE) inhibitors improve the prognosis in mild, moderate and severe
heart failure, as well as preventing the onset of
heart failure in patients with chronic asymptomatic
left-ventricular dysfunction and in those with reduced ejection fraction after
myocardial infarction (MI).
Imidapril is a long-acting
ACE inhibitor that is rapidly converted in the liver to its active metabolite,
imidaprilat. Maximum plasma concentrations of
imidapril and
imidaprilat are achieved after 2 and 5-6 hours, respectively, with corresponding elimination half-lives of 1.1-2.5 and 10-19 hours.
Imidapril is used in the treatment of
hypertension, chronic
heart failure, acute MI and
diabetic nephropathy. In patients with mild-to-moderate chronic
heart failure,
imidapril 10 mg once-daily increased exercise time and physical working capacity, decreased plasma
atrial natriuretic peptide and
brain natriuretic peptide levels and reduced blood pressure. It also improved left ventricular ejection fraction, being significantly more effective than
bisoprolol, in patients with acute MI.
Imidapril is well tolerated and preliminary studies suggest it has an advantage over
captopril and
enalapril in terms of a lower incidence of
cough. In conclusion,
imidapril is a well-investigated versatile
ACE inhibitor for the treatment of a range of
cardiovascular diseases.