lisinopril and Cardiac-Output--Low

The morbidity and mortality of cardiac insufficiency remains such that it justifies the pursuit of finding new drugs and new sensitive techniques to slow or abolish its evolution. Bringing the vasopeptidases, such as omapatrilat, up to date results in a rational process aimed at simultaneously modulating certain interactive humoral systems. They represent drugs which simultaneously inhibit neutral endopeptidase and angiotensin converting enzyme with the effect of potentiating the natiuretic peptide system and bradykinin, and blocking the conversion of angiotensin I and angiotensin II. In the IMPRESS study, omapatrilat has been evaluated in patients with cardiac insufficiency versus lisinopril; there was no significant difference on the principal outcome measure which was exercise tolerance, however it was significantly more effective than lisinopril on the outcome measure combining death and hospital admission for deteriorating cardiac insufficiency. A wider study is underway, the OVERTURE study, which is evaluating omapatrilat versus enalapril on hospital admission and all-cause mortality. The Vanlev dossier has not yet been submitted to the regulatory authorities for obtaining its authorisation to be put on the market.

Topics: Angiotensin-Converting Enzyme Inhibitors; Bradykinin; Cardiac Output, Low; Humans; Lisinopril; Natriuretic Agents; Peptide Hydrolases; Protease Inhibitors; Pyridines; Randomized Controlled Trials as Topic; Thiazepines

The Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT) provides a unique opportunity to compare the long-term relative safety and efficacy of angiotensin-converting enzyme inhibitor and calcium channel blocker-initiated therapy in older hypertensive individuals. Patients were randomized to amlodipine (n=9048) or lisinopril (n=9054). The primary outcome was combined fatal coronary heart disease or nonfatal myocardial infarction, analyzed by intention-to-treat. Secondary outcomes included all-cause mortality, stroke, combined cardiovascular disease (CVD), end-stage renal disease (ESRD), cancer, and gastrointestinal bleeding. Mean follow-up was 4.9 years. Blood pressure control was similar in nonblacks, but not in blacks. No significant differences were found between treatment groups for the primary outcome, all-cause mortality, ESRD, or cancer. Stroke rates were higher on lisinopril in blacks (RR=1.51, 95% CI 1.22 to 1.86) but not in nonblacks (RR=1.07, 95% CI 0.89 to 1.28), and in women (RR=1.45, 95% CI 1.17 to 1.79), but not in men (RR=1.10, 95% CI 0.92 to 1.31). Rates of combined CVD were higher (RR=1.06, 95% CI 1.00 to 1.12) because of higher rates for strokes, peripheral arterial disease, and angina, which were partly offset by lower rates for heart failure (RR=0.87, 95% CI 0.78 to 0.96) on lisinopril compared with amlodipine. Gastrointestinal bleeds and angioedema were higher on lisinopril. Patients with and without baseline coronary heart disease showed similar outcome patterns. We conclude that in hypertensive patients, the risks for coronary events are similar, but for stroke, combined CVD, gastrointestinal bleeding, and angioedema are higher and for heart failure are lower for lisinopril-based compared with amlodipine-based therapy. Some, but not all, of these differences may be explained by less effective blood pressure control in the lisinopril arm.

Topics: Amlodipine; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Black People; Blood Glucose; Blood Pressure; Calcium Channel Blockers; Cardiac Output, Low; Cardiovascular Diseases; Coronary Disease; Female; Gastrointestinal Hemorrhage; Glomerular Filtration Rate; Humans; Hypertension; Hypertrophy, Left Ventricular; Hypolipidemic Agents; Incidence; Lisinopril; Male; Middle Aged; Myocardial Infarction; Risk; Sex Distribution

Sudden unexpected death frequently occurs in chronic heart failure. The importance of acute coronary events in triggering sudden death (SD) is unclear.. We evaluated at autopsy the prevalence of acute coronary findings (coronary thrombus, ruptured plaque, or myocardial infarction [MI]) and their relation to SD. Autopsy results in 171 patients in the randomized ATLAS trial were reviewed. The prevalence of acute coronary findings was 33%: in 54% of patients with significant coronary artery disease (CAD) who died suddenly, 32% who died of myocardial failure, but in non-CAD patients, they were present in only 5% and 10% respectively. The percentage of patients classified as dying of MI was 28% in the autopsy group versus 4% in the nonautopsied group (P<0.0001). Of the autopsied group with acute MI, 97% (31 of 32 patients) with SD and 40% (6 of 15 patients) with myocardial failure did not have the MI diagnosed during life. When undiagnosed MI was classified as "sudden unexpected" or "myocardial failure" from clinical information only, the distribution of death causes was similar in the autopsy and nonautopsied groups.. Acute coronary findings are frequent and usually not clinically diagnosed in heart failure patients with CAD, particularly in those dying suddenly, suggesting the importance of acute coronary events as a trigger for SD in this setting.

Topics: Acute Disease; Autopsy; Cardiac Output, Low; Cardiotonic Agents; Cause of Death; Coronary Disease; Death, Sudden, Cardiac; Double-Blind Method; Humans; Incidence; Lisinopril; Myocardial Infarction; Prospective Studies; Survival Analysis

Lisinopril, a long-acting, angiotensin-converting enzyme inhibitor, was compared with placebo in a randomized, parallel, double-blind, 12-week study of 193 patients with heart failure. All patients were New York Heart Association Functional Class II, III, or IV and had remained symptomatic despite optimal dosing with digoxin and diuretics. After 12 weeks of therapy, the improvement in treadmill exercise duration was greater in the lisinopril group (113 seconds) compared with the placebo group (86 seconds). This improvement in exercise duration was particularly evident in patients with left ventricular ejection fractions less than 35% (lisinopril = 130 seconds; placebo = 94 seconds). In patients receiving lisinopril, the increase in exercise duration was accompanied by an improvement in quality of life as measured by the Yale Scale Dyspnea/Fatigue Index and in signs and symptoms of heart failure. In addition, the lisinopril group had a larger mean increase (3.7%) in left ventricular ejection fraction when compared with the placebo group (1.3%). Thus, lisinopril, administered once daily for 12 weeks, was well tolerated and efficacious in the treatment of heart failure when used concomitantly with diuretics and digoxin.

Topics: Aged; Cardiac Output, Low; Cardiotonic Agents; Digoxin; Diuretics; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Exercise Test; Female; Humans; Lisinopril; Male; Middle Aged; Quality of Life; Stroke Volume

Topics: Aged; Aged, 80 and over; Angiotensin-Converting Enzyme Inhibitors; Blood Pressure; Blood Pressure Monitors; Cardiac Output, Low; Circadian Rhythm; Dipeptides; Double-Blind Method; Enalapril; Heart Failure; Humans; Lisinopril; Middle Aged; Posture; Time Factors

Topics: Angiotensin-Converting Enzyme Inhibitors; Blood Pressure; Captopril; Cardiac Output, Low; Circadian Rhythm; Creatinine; Dipeptides; Female; Heart Failure; Heart Rate; Humans; Kidney; Lisinopril; Male; Middle Aged; Potassium; Renin

A study was undertaken to examine the effects of the angiotensin-converting enzyme inhibitor lisinopril on exercise performance in 18 patients with major impairment of left ventricular systolic function. The study was a randomized, double-blind, crossover design, and patients received treatment with either once-daily lisinopril (2.5-10 mg) or placebo for a period of 6 weeks. A total of 15 patients completed the study. Compared with placebo, lisinopril had no significant effect on supine or standing blood pressure or heart rate. Although lisinopril had no effect on exercise duration during a low-intensity exercise protocol, in patients undergoing a high-intensity exercise protocol, there was a trend toward improved exercise time and peak oxygen consumption improved significantly. In addition, treatment with lisinopril resulted in an increase in renal blood flow and a reduction in glomerular filtration rate. Moreover, administration of once-daily lisinopril 10 mg resulted in a decrease in plasma concentrations of angiotensin II, aldosterone, and atrial natriuretic peptide, and an increase in plasma concentrations of active renin.

Topics: Aldosterone; Angiotensin II; Angiotensin-Converting Enzyme Inhibitors; Atrial Natriuretic Factor; Blood Pressure; Cardiac Output, Low; Dipeptides; Double-Blind Method; Exercise Test; Glomerular Filtration Rate; Humans; Lisinopril; Male; Middle Aged; Oxygen Consumption; Placebos; Renal Circulation; Stroke Volume; Ventricular Function, Left

Once-daily lisinopril (5-20 mg) was compared with twice-daily captopril (12.5-50 mg) in a double-blind, randomized, parallel-group study of angiotensin-converting enzyme (ACE) inhibition conducted in 31 centers for 12 weeks in patients with heart failure (New York Heart Association class II-III) who were currently receiving digitalis and/or diuretics. The drugs were compared with regard to their effects on exercise duration, measured with bicycle ergometry, and on ectopic activity, measured using Holter monitoring. Both drugs significantly increased exercise duration after both 6 and 12 weeks of randomized treatment. Neither ACE inhibitor had any significant impact on the hourly rate of either ventricular ectopic counts or couplets, nor was there any difference between treatments with regard to the proportions of patients in whom ventricular ectopic counts were reduced. Both drugs were well tolerated, with no differences observed between treatments. Potassium, urea, and creatinine levels remained stable for both treatments throughout the study.

Topics: Adult; Aged; Aged, 80 and over; Angiotensin-Converting Enzyme Inhibitors; Arrhythmias, Cardiac; Captopril; Cardiac Output, Low; Creatinine; Digitalis Glycosides; Dipeptides; Diuretics; Double-Blind Method; Drug Administration Schedule; Electrocardiography, Ambulatory; Exercise Test; Female; Heart Failure; Humans; Lisinopril; Male; Middle Aged; Placebos; Potassium; Urea

A total of 12 patients (mean age +/- SEM 63 +/- 2.6 years) with moderate to severe heart failure (ejection fraction = 23 +/- 3.2%) were included in a placebo-controlled crossover trial. Patients were randomly allocated to 4 periods of 6 weeks each: placebo, placebo and physical training, lisinopril 10 mg daily, and lisinopril and physical training. The exercise time increased from 13.6 +/- 0.9 min with placebo to 15 +/- 1 min with training alone, and to 16.1 +/- 0.7 min with lisinopril and training. With lisinopril alone there was a non-significant increase in exercise time, to 14.5 +/- 0.6 min. Improvements in exercise time were accompanied by a similar increase in peak oxygen consumption. Overall, the most significant improvements in symptoms and indices of cardiorespiratory fitness were achieved with a combination of lisinopril and training. Thus physical training is not only a useful adjunct to the existing medical therapy for heart failure, but it may also provide symptomatic benefits in its own right.

Topics: Aged; Angiotensin-Converting Enzyme Inhibitors; Cardiac Output, Low; Combined Modality Therapy; Double-Blind Method; Enalapril; Exercise Therapy; Female; Humans; Lisinopril; Male; Middle Aged; Physical Exertion

Topics: Adrenergic beta-Antagonists; Aged; Carbazoles; Cardiac Output, Low; Cardiotonic Agents; Carvedilol; Exercise; Humans; Lisinopril; Myocardial Infarction; Propanolamines; Stroke Volume

To assess the effects of lisinopril (L) on mortality (M) rate and congestive heart failure (CHF), and the characteristics of geometrical myocardial remodeling and left ventricular function in rats with supravalvular aortic stenosis (SAS).. Some Wistar rats underwent SAS or the simulated surgery (CG, n=10). After 6 weeks, the animals were randomized to receive lisinopril (LG, n=30) or no treatment (SG, n=73) for 15 weeks. Cardiac remodeling was assessed in the sixth and 21st weeks after the surgical procedures through concomitant echocardiographic, hemodynamic, and morphological studies.. The M were 53.9% and 16.7% in SG and LG, respectively; the incidence of CHF was 44.8% and 20%, in SG and LG, respectively, (P<0.05). At the end of the experiment, the values of LV systolic pressure in SG and LG were equivalent and significantly greater than those in CG; (P<0.05) and did not differ from those observed 6 weeks after the surgical procedures. The values of LV diastolic pressure in SG were greater than those in LG; (P<0.05), and both were greater than those in CG; (P<0.05). The same behavior was observed with the following variables: E/A ratio; mass index; sectional area of the myocytes; and LV hydroxyproline content. Left ventricular shortening percentage was similar in CG and LG; (P>0.05), and both were greater than those in SG; (P<0.05). Similar results were obtained with the values of the positive and negative first derivate of LV pressure.. In rats with SAS, the treatment with L reduced M rate and ICC and had beneficial effects on geometrical myocardial remodeling and left ventricular function.

Topics: Angiotensin-Converting Enzyme Inhibitors; Animals; Aortic Stenosis, Supravalvular; Cardiac Output, Low; Hypertension; Hypertrophy, Left Ventricular; Lisinopril; Male; Random Allocation; Rats; Rats, Wistar; Time Factors; Ventricular Function, Left; Ventricular Remodeling

Inhibitors of angiotensin converting enzyme (ACE inhibitors) have been introduced more than fifteen years ago into the treatment of hypertension, congestive heart failure, myocardial infarction and diabetic nephropathy. The therapeutic success is related to their action in reduction of plasma and tissue angiotensin II concentrations and potentiation of endogenous kinins. They are able to improve myocardium metabolic status, prevent cardiac hypertrophy, limit myocardial infarct size, and thus prevent heart failure. Since 1987 ACE inhibitors are introduced in the clinical practice in our clinic. We introduced the therapy with lisinopril (Lopril), in 70% of patients among 2855 patients that were admitted in Coronary Care Unit in 1997 and 1998. Lisinopril was introduced as soon as the patient was admitted, together with fibrinolitic, Heparin and Aspirin therapy. Since that time we noticed decrease in postinfarction heart failure in comparison to previous years. We recommend permanent therapy with a small doses of ACE inhibitors in patients with heart infarction.

Topics: Angiotensin-Converting Enzyme Inhibitors; Cardiac Output, Low; Humans; Lisinopril; Myocardial Infarction

Topics: Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Cardiac Output, Low; Drug Synergism; Drug Therapy, Combination; Humans; Lisinopril; Losartan; Male; Middle Aged; Time Factors

Topics: Angiotensin-Converting Enzyme Inhibitors; Arrhythmias, Cardiac; Cardiac Output, Low; Dipeptides; Europe; Female; Heart Failure; Humans; Lisinopril; Male; Prognosis; Risk Factors

Topics: Angiotensin-Converting Enzyme Inhibitors; Blood Pressure; Captopril; Cardiac Output, Low; Circadian Rhythm; Dipeptides; Female; Heart Failure; Heart Rate; Humans; Lisinopril; Male; Middle Aged