lisinopril and Cerebrovascular-Disorders

To examine if angiotensin converting enzyme inhibitor reduces the risk of pneumonia in older patients on tube-feeding because of dysphagia from cerebrovascular diseases.. Randomized placebo-controlled trial.. Acute and subacute geriatrics units, speech therapists' clinic, and nursing home.. Older patients on tube-feeding for >2 weeks because of dysphagia secondary to cerebrovascular diseases.. Participants were randomized to lisinopril 2.5 mg or placebo once daily for 26 weeks.. Participants were followed up at weeks 12 and 26. The primary outcome was the incidence rate of pneumonia as determined by pneumonic changes on x-ray and clinical criteria. The secondary outcomes were mortality rate and swallowing ability as defined by the Royal Brisbane Hospital Outcome Measure for Swallowing at week 12.. A total of 93 older patients were randomized. In interim analysis, 71 completed the trial, whereas 15 had dropped out. Among those who had completed the trial, odds ratio (OR) for death was significantly higher in the intervention group (unadjusted OR 2.94, P = .030; fully adjusted OR 7.79, P = .018). There was no difference in the incidence of pneumonia or fatal pneumonia in the 2 groups. The intervention group had a marginally better swallowing function at week 12 (Royal Brisbane Hospital Outcome Measure for Swallowing score: 4.2 ± 1.5 in intervention group, 3.5 ± 1.5 in placebo group, P = .053). As a result of the interim finding on mortality, the trial was prematurely terminated with 7 participants still in the trial.. Low dose lisinopril given to older tube-fed patients with neurologic dysphagia resulted in increased mortality, although swallowing function showed marginal improvement. ACE inhibitors did not prevent pneumonia in older patients with neurologic dysphagia and might increase mortality.

Topics: Aged; Angiotensin-Converting Enzyme Inhibitors; Cerebrovascular Disorders; Deglutition Disorders; Enteral Nutrition; Female; Hong Kong; Humans; Incidence; Lisinopril; Male; Middle Aged; Placebos; Pneumonia, Aspiration; Risk Factors; Treatment Outcome

Topics: Aged; Aged, 80 and over; Bendroflumethiazide; Cerebrovascular Disorders; Humans; Hypertension; Lisinopril

Topics: Angiotensin-Converting Enzyme Inhibitors; Cerebrovascular Disorders; Deglutition Disorders; Female; Humans; Lisinopril; Male; Pneumonia, Aspiration

Topics: Angiotensin-Converting Enzyme Inhibitors; Cerebrovascular Disorders; Deglutition Disorders; Female; Humans; Lisinopril; Male; Pneumonia, Aspiration

Stroke in sickle cell anaemia (SCA) is either infarctive or haemorrhagic in nature. In childhood, over 75% of strokes in SCA are infarctive. We present an adolescent with SCA who developed hypertension at the age of 13, and was treated with lisinopril. Sixteen months later she was found in cardiorespiratory arrest and died on arrival in hospital. The last transcranial Doppler scan performed 6 months before her death and a brain MRI were reported normal. The autopsy discovered massive subarachnoid haemorrhage in association with vascular damage in the circle of Willis arteries. The case highlights a cause of haemorrhagic stroke, the first reported association between hypertension, SCA and a histopathologically proven cerebral vasculopathy. The difficulties in the management of haemorrhagic stroke and the poor outcome in SCA are discussed.

Topics: Adolescent; Anemia, Sickle Cell; Angiotensin-Converting Enzyme Inhibitors; Cerebrovascular Disorders; Circle of Willis; Fatal Outcome; Female; Humans; Hypertension; Lisinopril; Subarachnoid Hemorrhage

The use of up-to-date diagnostic methods for the examination of 72 patients presenting with grade II-III arterial hypertension and high risk of cardiovascular complications made it possible to estimate the state of brachiocephalic arteries before and after combined antihypertensive therapy that continued during 14 days. The following variables were measured: blood flow rate, peripheral vascular resistance indices at the extra- and intracranial levels, metabolic indices of cerebrovascular responsiveness, and coefficient of variability as an indicator of the cerebrovascular reserve capacity under conditions of antihypertensive treatment. Three antihypertensive therapeutic regimens were employed, viz. lisinopril plus indapamide, bisoprolol plus indapamide, and amlodipine plus indapamide. It was shown that all the three regimen resulted in positive changes in the parameters of blood flow and peripheral vascular resistance. At the same time, the use of amlodipine plus indapamide ensured a more gradual reduction of peripheral vascular resistance and the most pronounced increase of cerebrovascular reserve capacity compared with the two remaining regimens. It is concluded that the parameters of peripheral vascular resistance and metabolic indices of cerebrovascular responsiveness are the most sensitive and informative end points for the pharmacotherapeutic treatment of cerebral hemodynamics in the patients presenting with grade II-III arterial hypertension and high risk of development of cardiovascular complications.

Topics: Amlodipine; Antihypertensive Agents; Bisoprolol; Cerebrovascular Disorders; Drug Therapy, Combination; Humans; Hypertension; Indapamide; Lisinopril; Middle Aged; Random Allocation; Severity of Illness Index; Treatment Outcome

In 102 patients with high risk (52 patients with history of myocardial infarction, 50 patients with history of cerebral stroke within previous 6-48 months) arterial hypertension (AH) we studied clinical efficacy on angiotensin converting enzyme inhibitor (ACEI) lisinopril, calcium antagonist felodipine, and nonselective - -blocker carvedilol in dependence on salt sensitivity of AH. Efficacy of treatment was assessed with the help of office pressure measurement and 24 hour arterial pressure monitoring before and after 12 weeks of therapy. Patients who showed 10 or more mm Hg lowering of AP at transition from high salt (15 g/day) to low salt ( 3 g/day) diet were considered salt sensitive. On the basis of obtained results optimal for the treatment of AH in salt resistant patients are ACEI while in the treatment of salt sensitive patients it is expedient to administer calcium antagonists. The use of -adrenoblockers is equally effective in AH with various salt sensitivity.

Topics: Antihypertensive Agents; Blood Pressure; Blood Pressure Monitoring, Ambulatory; Carbazoles; Carvedilol; Cerebrovascular Disorders; Drug Monitoring; Felodipine; Female; Humans; Hypertension; Lisinopril; Male; Middle Aged; Myocardial Ischemia; Propanolamines; Sodium Chloride, Dietary; Treatment Outcome

Topics: Aged; Cerebrovascular Disorders; Chemical and Drug Induced Liver Injury; Enalapril; Female; Humans; Lisinopril