Effects of fosinopril on the blood pressure and lipid profile of patients undergoing heart transplantation.
OBJECTIVE
The purpose of this study was to determine whether the angiotensin-converting enzyme inhibitor, fosinopril, has an antihypertensive effect in patients undergoing heart transplantation (HT), as well as any action on lipid levels (total cholesterol and its fractions, triglycerides and lipoprotein[a] [Lp(a)]).


METHODS
The study included 15 male patients aged 54 +/- 10 years; nine had undergone transplantation as a result of ischemic heart disease and six as a result of idiopathic dilated cardiomyopathy. The average time from the heart transplantation was 12 +/- 4 months. Six transplantations were performed after antidiabetic treatment, and six were performed with patients receiving a hypolipidemic agent. The subjects of the study were patients with mild to moderate hypertension who were receiving antihypertensive treatment; the antihypertensive medications were withdrawn during 7 days. Periodic blood pressure and basal analytic determinations were then carried out after 4 and 12 weeks of treatment and 7 days after withdrawal of the antihypertensive medications.


RESULTS
Significant differences (p < 0.05) were found in the systolic blood pressure (SBP) and diastolic blood pressure (DBP) compared with the basal values (SBP 160 +/- 11 mm Hg; DBP 98 +/- 8 mm Hg), after 4 weeks of treatment (SBP 138 +/- 10 mm Hg; DBP 83 +/- 7 mm Hg), and after 12 weeks of treatment (SBP 137 +/- 12 mm Hg; DBP 84 +/- 9 mm Hg); these differences persisted 7 days after the drug was withdrawn (SBP 150 +/- 12 mm Hg; DBP 95 +/- 10 mm Hg). The total cholesterol, low-density lipoprotein (LDL) cholesterol, and Lp(a) dropped compared with the basal levels (total cholesterol 184 +/- 19, LDL cholesterol 123 +/- 13, Lp(a) 29 +/- 12), after 4 weeks (total cholesterol 172 +/- 21, LDL cholesterol 116 +/- 8, Lp(a) 26 +/- 8) and after 12 weeks (total cholesterol 169 +/- 20, LDL cholesterol 115 +/- 6, Lp(a) 25 +/- 8) of treatment, returning to basal values on withdrawal of the drug.


CONCLUSIONS
Fosinopril is a useful drug for the treatment of the mild to moderate arterial hypertension of heart transplant recipients, in addition to being capable of reducing the serum levels of total cholesterol, LDL cholesterol, and Lp(a). It should therefore be considered a first-line antihypertensive agent with beneficial effects on the lipid profile.
Almenar
L
L
Cardiology Service, Hospital Universitario La Fe, Servicio Valenciano de Salud, Valencia, Spain.
Osa
A
A
Palencia
M
M
Flores
A
A
Sánchez
E
E
D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects* / Q000502:physiology; D002784:Cholesterol / Q000097:blood; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D017328:Fosinopril / Q000008:administration & dosage* / Q000009:adverse effects; D016027:Heart Transplantation / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology; D008055:Lipids / Q000097:blood*; D017270:Lipoprotein(a) / Q000097:blood; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy / Q000503:physiopathology; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood
D000806:Angiotensin-Converting Enzyme Inhibitors; D008055:Lipids; D017270:Lipoprotein(a); D014280:Triglycerides; D002784:Cholesterol; D017328:Fosinopril