title: ACE-inhibitor therapy with spirapril increases nocturnal hypotensive episodes in elderly hypertensive patients.
abstract: The purpose of this double-blind, randomised trial with a 4-week placebo run-in period followed by an active treatment period using either spirapril 3 mg or 6 mg once a day was to clarify the existence of hypotensive episodes in elderly hypertensive patients treated by an ACE-inhibitor. Forty hypertensive patients aged 60-76 years underwent 24-h ABPM at the end of the run-in (week 4) and active treatment (week 9) periods. The mean 24-h systolic blood pressure (SBP) decreased from 161.9 (26.7) mm Hg to 150.6 (29.9) mm Hg (P < 0.001) and diastolic blood pressure (DBP) from 91.70 (14.7) mm Hg to 84.2 (17.3) mm Hg (P < 0.001). No episodes of mean arterial pressure (MAP) <50 mm Hg were seen during the placebo period. Instead 11 episodes were observed during the antihypertensive treatment (one in the 3 mg group and 10 in the 6 mg group, P < 0.01 between the two treatment groups). Fifty-four episodes of MAP <70 mm Hg were observed during the placebo period and 117 during the treatment period (P < 0.001). During the placebo period low MAPs were observed only during night time. During the treatment period they were seen also from 11 am to 4 pm. In conclusion, ACE-inhibitor therapy with spirapril significantly increased hypotensive episodes in elderly hypertensive patients which may worsen their cerebral and myocardial circulation.
authors.affiliation: Department of Medicine, Turku University Central Hospital, FIN-20520 Turku, Finland. ilkka.kantola@tyks.fi
authors.forename: I
authors.initials: I
authors.lastname: Kantola
authors.forename: A
authors.initials: A
authors.lastname: Terént
authors.forename: M
authors.initials: M
authors.lastname: Kataja
authors.forename: E
authors.initials: E
authors.lastname: Breig-Asberg
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage*; D018660:Blood Pressure Monitoring, Ambulatory; D016009:Chi-Square Distribution; D002940:Circadian Rhythm; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004656:Enalapril / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000188:drug therapy*; D007022:Hypotension / Q000139:chemically induced* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D004656:Enalapril; C052555:spirapril