The
antihypertensive and hormonal effects of a new
ACE-inhibitor,
lisinopril (MK-521), was studied in 11 patients with renal arterial
stenosis (bilateral in 1). Oral doses exceeding 5 mg a day significantly reduced blood pressure (BP), the maximum fall occurring 6 h after taking the
drug. At higher doses (20-80 mg/day) sustained
antihypertensive effects persisted for 24 h.
Lisinopril was equally effective in lowering supine and standing BP. When the
drug was given stepwise in increasing doses, (5, 10, 20, 40, and in 5 cases 80 mg/day) the BP was successively normalized in 10 of 11 patients (supine BP less than 90 mmHg). 3 patients with low
renin hypertension (LRH) responded less well to monotherapy on long-term treatment with
lisinopril than the others. A significant increase in heart rate was observed, initially and after 1 month of treatment. After 5 days treatment with increasing doses the plasma concentrations of
angiotensin II (AII) and
aldosterone (Aldo) fell significantly to very low concentrations. However, on long term treatment (3 months) suppression of AII and Aldo did not always take place. A concomitant decrease in 24 h urinary
aldosterone excretion occurred. No changes in renal function or other biochemical tests except for a slight increase in S-K were observed. There were no adverse side-effects. We conclude that
lisinopril is an effective and safe medication for
renovascular hypertension.