Treatment of Hypertension with Lisinopril in End-Stage Renal Failure

Lisinopril (L), a novel angiotensin converting enzyme inhibitor, was studied as sole drug in the management of hypertensive, dialysis-treated, end-stage renal failure patients to assess its efficiency, tolerance, and removal by dialysis. High blood pressure (BP) was defined as sitting diastolic (D) BP ± 95 mm Hg. Ten patients, two females and eight males, were treated for 12 weeks. Their features were age 49 ± 14 years; dialysis duration 43 ± 25 months; body weight 61 ± 10 kg; and body mass index 21.7 ± 3 (mean ± SD). Serum L concentrations were measured regularly by radioimmunoassay, both before and after dialysis, which was performed with Cuprophane membranes three times per week. L, 2.5 mg orally, was given every 24 h initially; in six patients, dosage was decreased to an alternate or once-a-week schedule, because of a hypotensive effect during dialysis. At 12 weeks, BP—as compared to prestudy BP—was de-creased in eight of nine patients (one patient had been withdrawn after kidney transplantation), and not changed in one patient (mean ± SD)sitting DBP from 107 ± 7 to 87 ± 10 mm Hg, p < 0.001; erect DBP from 105 ± 5 to 86 ± 10 mm Hg, p ± 0.001. L serum concentration was decreased by dialysis, the mean ratio of post-/predialysis serum L concentrations was 0.47 ± 0.07 (n = 67). No side effects were disclosed, except for three patients, in whom hemoglobin decreased, while two of them also received quinine for a febrile illness of viral origin. To conclude (a) L is an efficient treatment of high BP in many, but possibly not all, dialyzed patients and dosage may be about 1–2 mg every 24 h; (h) during a 12 week period, no side effects were seen, except for a worsening of anemia in three patients, two of them concomitantly treated with another drug; (c) L is dialyzable4 h dialysis with a Cuprophane membrane decreases L serum concentration by about 50%.