Lisinopril, the
lysine analogue of
enalaprilat, is a long-acting
angiotensin converting enzyme (
ACE) inhibitor which is administered once daily by mouth. The efficacy of
lisinopril in reducing blood pressure is well established in younger populations, and many trials now show it to be effective in lowering blood pressure in elderly patients with
hypertension. In comparative and non-comparative clinical trials, 68.2 to 89.1% of elderly patients responded (diastolic pressure < or = 90 mm Hg) to > or = 8 weeks'
lisinopril treatment. Age-related differences in
antihypertensive efficacy do not appear to be clinically significant, and dosages effective in elderly patients tend to range from 2.5 to 40 mg/day. Dosages usually need to be lower in patients with significant renal impairment. In
congestive heart failure,
lisinopril 2.5 to 20 mg/day increases exercise duration, improves left ventricular ejection fraction and has no significant effect on
ventricular ectopic beats. It is similar in efficacy to
enalapril and
digoxin and similar or superior to
captopril on most end-points. Data from the GISSI-3 post-
myocardial infarction trial show that
lisinopril reduced mortality and
left ventricular dysfunction when given for 42 days starting within 24 hours of the onset of
infarction symptoms. Results at 6 weeks and 6 months were similar in elderly and younger patients. Elderly patients, however, among other subgroups, exhibited a strong reduction in risk of low ejection fraction
after treatment (-25.5%). Economic studies suggest that
lisinopril is cost saving compared with other
ACE inhibitors in some markets. When given according to the GISSI-3 protocol,
lisinopril appears to be one of the less expensive of the successful
ACE inhibitor regimens for acute
myocardial infarction. In other trials, patients with
diabetic nephropathy and
hypertension improved or did not deteriorate during
lisinopril treatment. Blood pressure was controlled and reductions or trends towards reductions in
albuminuria were observed. These reductions were similar to those in
diltiazem,
nifedipine and
verapamil recipients, and greater than those in patients receiving
atenolol.
Lisinopril appears to reduce mortality in diabetic patients after
myocardial infarction and may also improve neuropathy associated with diabetes.
Lisinopril is well tolerated and the profile of adverse events seen is typical of
ACE inhibitors as a class. There is a tendency for more elderly than younger patients to discontinue treatment, but this trend is not clearly related to the incidence of adverse events in these age groups. Drug interactions occur with few other agents and are usually clinically significant only between
lisinopril and either
diuretics or
lithium.
Lisinopril is, thus, an effective treatment for elderly patients with
hypertension,
congestive heart failure and acute
myocardial infarction and has shown promising benefits in patients with
diabetic nephropathy.