title: Modulation of hemodynamic effects with a converting enzyme inhibitor: acute hemodynamic dose-response relationship of a new angiotensin converting enzyme inhibitor, lisinopril, with observations on long-term clinical, functional, and biochemical responses.
abstract: The hemodynamic effects of varying oral doses of the long-acting converting enzyme inhibitor lisinopril were studied in an acute, single-blind, parallel fashion in 55 patients with moderate to severe congestive heart failure. Doses of 2.5, 5.0, and 10 mg produced a significant increase in cardiac index and significant reductions in pulmonary capillary wedge, right atrial, pulmonary arterial, and systemic arterial pressures and systemic vascular resistance. The changes were present up to 24 hours after dosing for most parameters. There was a clear-cut dose-response relationship observed. Forty-seven patients were followed over a 3-month period, during which functional status and exercise tolerance improved. Although 26% showed some evidence of renal dysfunction with lisinopril, these changes could be normalized by decreasing either the lisinopril or the diuretic dose. These data demonstrate that the hemodynamic changes with the long-acting converting enzyme inhibitor lisinopril can be modulated with dose adjustment in patients with congestive heart failure. They also suggest that renal function changes may be normalized by adjustment of either the dose of lisinopril or the diuretic dose.
authors.affiliation: Presbyterian University Hospital, Pittsburgh, PA 15213.
authors.forename: B F
authors.initials: BF
authors.lastname: Uretsky
authors.forename: J A
authors.initials: JA
authors.lastname: Shaver
authors.forename: C S
authors.initials: CS
authors.lastname: Liang
authors.forename: D
authors.initials: D
authors.lastname: Amin
authors.forename: P K
authors.initials: PK
authors.lastname: Shah
authors.forename: T B
authors.initials: TB
authors.lastname: Levine
authors.forename: P
authors.initials: P
authors.lastname: Walinsky
authors.forename: T
authors.initials: T
authors.lastname: LeJemtel
authors.forename: T
authors.initials: T
authors.lastname: Linnemeier
authors.forename: J E
authors.initials: JE
authors.lastname: Rush
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D002302:Cardiac Output / Q000187:drug effects; D002986:Clinical Trials as Topic; D004305:Dose-Response Relationship, Drug; D004656:Enalapril / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D017706:Lisinopril; D008297:Male; D008875:Middle Aged; D011669:Pulmonary Wedge Pressure / Q000187:drug effects; D011897:Random Allocation; D013997:Time Factors
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D004656:Enalapril; D017706:Lisinopril