Benefits of getting off lisinopril
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Benefits of Discontinuing Lisinopril
Lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, is widely used for managing hypertension, heart failure, and acute myocardial infarction. However, there are potential benefits to discontinuing its use under certain circumstances. This article explores the advantages of stopping lisinopril, supported by various research findings.
Improved Renin-Angiotensin System Blockade
Incomplete Blockade with Lisinopril Monotherapy
While lisinopril effectively reduces blood pressure and albumin excretion rate (AER) in patients with type 2 diabetes, hypertension, and microalbuminuria, its monotherapy may result in incomplete blockade of the renin-angiotensin system. Studies have shown that combining lisinopril with an angiotensin II receptor blocker (ARB) like telmisartan provides superior control over blood pressure and AER compared to lisinopril alone. This suggests that discontinuing lisinopril in favor of a dual blockade approach could offer enhanced therapeutic benefits.
Sustained Benefits Post-Discontinuation
Long-Term Effects After Acute Myocardial Infarction
Research from the GISSI-3 trial indicates that early treatment with lisinopril after an acute myocardial infarction (MI) significantly reduces mortality and severe left ventricular dysfunction. Interestingly, these benefits persist even after discontinuing the drug. At six months post-MI, patients who had been treated with lisinopril showed a lower combined incidence of mortality and severe ventricular dysfunction compared to those who did not receive the drug, despite the treatment being stopped after six weeks . This finding suggests that the early benefits of lisinopril can have lasting effects, reducing the need for prolonged use.
Reduced Mortality in Diabetic Patients
Short-Term Use in Acute Myocardial Infarction
For diabetic patients with acute MI, early administration of lisinopril has been associated with a significant reduction in six-week mortality rates. This benefit is largely maintained at six months, even after discontinuing the drug at six weeks. Therefore, short-term use of lisinopril can provide substantial survival benefits without the necessity for long-term treatment, potentially reducing the risk of side effects associated with prolonged use.
Considerations for Discontinuation
Patient-Specific Factors
While the benefits of discontinuing lisinopril can be significant, it is crucial to consider patient-specific factors such as the presence of left ventricular dysfunction, overall cardiovascular risk, and the potential for adverse effects. For patients who are hemodynamically stable and have no contraindications, discontinuing lisinopril after achieving initial therapeutic goals may be a viable option.
Conclusion
Discontinuing lisinopril can offer several benefits, including improved renin-angiotensin system blockade when switching to a dual therapy approach, sustained long-term benefits post-acute myocardial infarction, and reduced mortality in diabetic patients with acute MI. However, the decision to stop lisinopril should be individualized, taking into account the patient's overall health status and specific medical conditions.
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