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Immediate blood pressure effects of the renin inhibitor enalkiren and the angiotensin-converting enzyme inhibitor enalaprilat

1991; Elsevier BV; Volume: 122; Issue: 4 Linguagem: Inglês

10.1016/0002-8703(91)90477-y

1097-6744

Joel M. Neutel, Robert R. Luther, R. Boger, Michael A. Weber,

Heart Failure Treatment and Management

The antihypertensive effects of the renin inhibitor enalkiren were compared with those of the angiotensin-converting enzyme inhibitor enalaprllat in 17 hypertensive patients (14 white, 3 black; mean age 57 years), whose renin systems had been stimulated by diuretic pretreatment. Patients were studied on 3 separate in-hospital days. On the first study day patients received placebo alone. On day 2 they received intravenous bolus doses of enalkiren (0.03 to 1.0 mg/kg), and on day 3, intravenous bolus doses of enalaprilat (0.625 to 1.25 mg). Each agent reduced systolic (p < 0.01) and diastolic (p < 0.01) blood pressures (BP) from baseline levels. The acute decrease in systolic BP of 18.5 ± 0.4 mm Hg during enalkiren tended to be greater (p < 0.01) than the decrease of 12.6 ± 0.7 mm Hg during enalaprilat. Decreases in diastolic BP during enalkiren (11.9 ± 0.4 mm Hg) were also slightly greater (p < 0.1) than those during enalaprilat (9.2 ± 0.4 mm Hg). Based on prestudy plasma renin activity (PRA), patients were divided into "high" renin (PRA >3.5 ng angiotensin l/ml/hr; n = 6) and "low/normal" renin (<3.5 ng angiotensin l/ml/hr; n = 11) groups. Reductions in diastolic BP in the "high" renin group during enalkiren (30 ± 520 ± 3mm Hg) tended to be greater (p < 0.07) than those during enalaprilat (23 ± 714 ± 1mm Hg); differences were not significant in the "low/normal" group (12 ± 27 ± 2 and 7 ± 28 ± 1 mm Hg, respectively). Thus the renin inhibitor is at least as effective as the ACE inhibitor in its immediate BP-lowering effects in hypertensive patients.