enalapril and Scleroderma--Systemic

The ESS-1 study was designed to evaluate the long-term effects of the angiotensin converting enzyme inhibitor (ACEI) enalapril (10 mg per day) on the cardio-pulmonary system in patients with scleroderma (SSc). We estimated changes in heart diameters, systolic and diastolic left ventricle function and mean values of pulmonary artery pressure after 3 months treatment. The study group comprise 41 patients with SSc. 18 patients received placebo and 23 ones were given enalapril. After 3 months of treatment we did not observe statistically significant differences in heart diameters and left ventricle systolic function parameters between treated group and placebo. Enalapril therapy did not affect left ventricle diastolic function, nevertheless differences in MVA were almost of statistical significance. Echocardiographic signs of pulmonary hypertension were found in 4 patients.

Topics: Adult; Angiotensin-Converting Enzyme Inhibitors; Double-Blind Method; Echocardiography; Enalapril; Female; Follow-Up Studies; Humans; Hypertension, Pulmonary; Male; Middle Aged; Scleroderma, Systemic; Ventricular Function, Left

The ESS-1 study was designed to evaluate the long-term effects of the angiotensin-converting enzyme inhibitor (ACEI) enalapril (10 mg per day) on cardiopulmonary system of patients with systemic sclerosis (SSc). Exercise testing is used not only for estimation of coronary reserve but also physical capacity--the major determinant of quality of life. In each patient included to the ESS-1 study we performed ECG exercise test on treadmill (5 times at intervals of 3 months). The first follow-up was completed by 41 patients (23 patients in enalapril group and 18 in placebo group). The exercise duration in the placebo group was 683 +/- 295 sec and in enalapril group 768 +/- 173 sec. After 3 months of study there were no significant differences in both groups (758 +/- 271 sec and 720 +/- 191 sec respectively). The analysis of ST segment deviation did not provide any significant changes after 3 months of treatment. We conclude that 3 months enalapril treatment did not improve exercise tolerance in patients with systemic sclerosis.

Topics: Adult; Angiotensin-Converting Enzyme Inhibitors; Blood Pressure; Double-Blind Method; Electrocardiography; Enalapril; Exercise Test; Exercise Tolerance; Female; Follow-Up Studies; Heart Rate; Humans; Male; Middle Aged; Scleroderma, Systemic

The ESS-1 study is designed to evaluate the long-term effects of enalapril on cardiopulmonary system of patients with systemic sclerosis (SSc). During the one year study period 5 visits are scheduled at 3 months intervals. The effect of 3 months treatment with enalapril (10 mg per day) on lung function was studied in 18 patients with SSc (enalapril group) and compared with controls--23 patients with Ssc (placebo group), mean age, SSc duration, gender and % of patients with dcSSc did not differ significantly in both groups. We performed body plethysmography for total airways resistance (Rtot), and static lung volumes (TLC, ITGV and RV), spirometry for FEV1 and FVC and we measured flow parameters (PEF, FEF). We compared initial lung function (first examination) with results after 3 months treatment (second examination) in the enalapril and in the placebo group. Mean values of Rtot, ITGV and RV did not differ significantly in the enalapril group or in the placebo group before and after treatment but FVC, FEV1 and FEF50 were significantly lower in the enalapril group and did not change in the placebo group after three months. We conclude that 3 month treatment with enalapril worsens spirometry of SSc patients. We did not observe any changes in lung functions in the control group in the same three month period.

Topics: Adult; Angiotensin-Converting Enzyme Inhibitors; Double-Blind Method; Enalapril; Female; Follow-Up Studies; Humans; Lung Diseases; Male; Middle Aged; Respiratory Function Tests; Scleroderma, Systemic

The ESS-1 study was designed to evaluate the long-term effects of enalapril (10 mg per day) on the cardiopulmonary system of patients with systemic sclerosis (SSc). The 3 months follow-up was completed by 41 patients (23 patients in enalapril group and 18 in placebo group). We analysed conventional time domain signal averaged ECG (SAECG). Late potentials were considered to be present in QRS duration (QRS) was > 114 ms or root mean square of last 40 ms (RMS40) was < 20 microV or terminal signal duration under 40 microV (LAS40) was > 38 ms at 40 Hz. At the beginning of study the prevalence of abnormal SAEG parameters was similar in both groups. We observed one abnormal parameter among 13% of patients in enalapril group and 16.7% of patients in placebo group. There were 2 abnormal parameters in 26.1% of patients in enalapril group and 16.7% of patients in placebo group. After three months of treatment we did not find any patient with 2 parameters of late potentials in enalapril group and only 8.7% of patients with one such parameter. In placebo group no substantial improvement was observed.. The 3 months enalapril treatment seems to decrease the incidence of late potentials in patients with systemic sclerosis.

Topics: Adult; Angiotensin-Converting Enzyme Inhibitors; Double-Blind Method; Electrocardiography; Enalapril; Female; Fibrosis; Follow-Up Studies; Humans; Male; Middle Aged; Scleroderma, Systemic

Topics: Aged; Biopsy; Enalapril; Female; Humans; Hypertension; Kidney; Renal Dialysis; Renal Insufficiency; Scleroderma, Systemic; Sjogren's Syndrome; Tetrazoles; Treatment Outcome; Valine; Valsartan

Topics: Antihypertensive Agents; Child; Enalapril; Female; Glomerulonephritis, Membranous; Humans; Nephrotic Syndrome; Scleroderma, Systemic

A 60 year old male patient having systemic scleroderma and normotensive scleroderma renal crisis was admitted in our hospital. He presented polyarticular, esophagic, lung and skin compromise. Before admission he had been treated with high doses of corticosteroids. We believe corticosteroids led to the worsening of renal damage with renal failure, microangiopathic hemolytic anemia without high blood pressure. The 10% of these cases have normal blood pressure. The patient was treated with enalapril and hemodialysis. There was no favourable response to this treatment and he died seven days after admission.

Topics: Acute Kidney Injury; Adrenal Cortex Hormones; Anemia, Hemolytic; Angiotensin-Converting Enzyme Inhibitors; Blood Pressure; Enalapril; Fatal Outcome; Humans; Male; Middle Aged; Renal Dialysis; Scleroderma, Systemic

Topics: Adult; Angiotensin-Converting Enzyme Inhibitors; Enalapril; Female; Humans; Kidney Diseases; Scleroderma, Systemic

Topics: Adult; Enalapril; Female; Humans; Scleroderma, Systemic

Topics: Enalapril; Female; Humans; Hypertension; Kidney Failure, Chronic; Middle Aged; Scleroderma, Systemic

A patient with scleroderma renal crisis is described. At presentation he had severe hypertension, deteriorating renal function, microangiopathic haemolytic anaemia, and elevated levels of renin, aldosterone and noradrenaline. Enalapril controlled blood pressure, stabilized renal function, lowered aldosterone and noradrenaline levels, and improved peripheral circulation. It appears that converting-enzyme inhibitors can favourably alter the outlook of this otherwise fatal disorder.

Topics: Acute Kidney Injury; Enalapril; Humans; Hypertension, Renal; Male; Middle Aged; Scleroderma, Systemic

A 74-year-old man has been known to have scleroderma for 5 years. Two months before the hospitalization, his blood pressure was rapidly elevated, and progressive renal impairment and ulcerations of the fingers manifested. Then he was diagnosed to have a crisis of scleroderma. The treatment with a new long-acting angiotensin I converting enzyme inhibitor, enalapril maleate (MK-421), normalized the blood pressure and protected the progress of renal impairment without side effects.

Topics: Aged; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Dipeptides; Enalapril; Humans; Kidney Diseases; Male; Scleroderma, Systemic

Topics: Adult; Angiotensin-Converting Enzyme Inhibitors; Captopril; Dipeptides; Drug Tolerance; Enalapril; Female; Humans; Hypertension, Malignant; Male; Middle Aged; Proline; Scleroderma, Systemic