Systolic blood pressure reduction with lisinopril (MK-521) in elderly patients with essential arterial hypertension

Abstract

Lisinopril (MK-521) is a new long-acting, non-sulphydryl, angiotensin converting enzyme (ACE) inhibitor that reduces blood pressure in hypertensive subjects. Low plasma renin and other factors can impair blood pressure reduction in the elderly (>65 years old) during ACE inhibitor treatment. Lisinopril studies have shown pharmacokinetic differences between elderly and non-elderly subjects. Peak serum lisinopril concentration is twice as high in the elderly compared with the non-elderly and there is a slight delay in reaching the maximum drug concentration in the elderly. During four 12-week, multicentre, double-blind protocols with 1168 subjects, 139 elderly hypertensive patients were studied to compare lisinopril (20–80 mg/day) with hydrochlorothiazide (HCTZ 12.5–50 mg/day) alone, with lisinopril + HCTZ combined (20+ 12.5 to 80 + 50 mg/day, respectively), and separately with atenolol (50–200 mg/day), metoprolol (100–200 mg/day) and nifedipine (40–80 mg/day). When compared to baseline blood pressure in all four studies, reductions in sitting diastolic blood pressure and sitting systolic blood pressure were significant (P; ≤ 0.01 to ≤ 0.05) for all drug treatments. During all four studies lisinopril reduced sitting diastolic blood pressure by 11.1–17.7 mmHg and sitting systolic blood pressure by 21.0–26.1 mmHg. The other four monotherapy drug regimens lowered sitting diastolic blood pressure by 9.0–21.0 mmHg and sitting systolic blood pressure by 14.2–34.2 mmHg, but there were no significant differences when lisinopril was compared with HCTZ, atenolol, metoprolol or nifedipine in either elderly or non-elderly patients. There were no serious adverse drug effects during lisinopril treatment. These data suggest that lisinopril is effective and well tolerated for the reduction of both systolic and diastolic blood pressure in elderly patients with uncomplicated essential hypertension.