Diuretic lisinopril
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Efficacy and Safety of Lisinopril as a Diuretic in Hypertensive and Heart Failure Patients
Introduction to Lisinopril and Hydrochlorothiazide
Lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, and hydrochlorothiazide, a thiazide diuretic, are commonly used medications for managing hypertension and heart failure. Both drugs have distinct mechanisms of action and are often compared to determine their efficacy and safety in various patient populations.
Comparative Efficacy in Hypertension
Blood Pressure Reduction
In a multicenter, double-blind trial involving 232 obese hypertensive patients, both lisinopril and hydrochlorothiazide significantly reduced office diastolic and systolic blood pressures compared to placebo. Lisinopril showed a slightly higher efficacy in reducing diastolic pressure, with 60% of patients achieving a diastolic pressure below 90 mm Hg, compared to 43% with hydrochlorothiazide. Ambulatory blood pressure monitoring confirmed these findings, indicating that both medications effectively lower 24-hour blood pressure.
Metabolic Effects
Lisinopril and hydrochlorothiazide have different impacts on metabolic parameters. Hydrochlorothiazide was associated with an increase in plasma glucose levels and a decrease in serum potassium, whereas lisinopril did not significantly affect insulin or lipid profiles and had a more favorable impact on plasma glucose.
Platelet Function and Blood Rheology
A study comparing the effects of lisinopril and hydrochlorothiazide on platelet function and blood rheology found that both drugs lowered blood pressure effectively without significantly altering platelet counts or aggregation. However, lisinopril showed a tendency to improve blood rheology by increasing erythrocyte aggregation time and decreasing disaggregation shear stress, suggesting potential benefits in reducing atherosclerotic and thrombotic complications.
Discontinuation of Diuretics in Heart Failure
A clinical trial assessed the feasibility of discontinuing diuretic therapy in stable congestive heart failure (CHF) patients while continuing background CHF therapy with either lisinopril or placebo. The study found that 29% of patients did not require reinitiation of diuretic therapy, and the probability of remaining diuretic-free was higher in patients with a lower baseline furosemide dose, higher left ventricular ejection fraction, and no history of systemic hypertension. This suggests that lisinopril may help maintain stability in certain CHF patients without the need for continuous diuretic therapy.
Combination Therapy in Hypertension
Fixed-Dose Combinations
The FIXLINDA study evaluated the efficacy of a fixed-dose combination of lisinopril and the long-acting diuretic indapamide in hypertensive patients. The combination therapy was effective in achieving target blood pressure in a significant proportion of patients and improved circadian blood pressure and diuresis profiles. The treatment was well-tolerated with minimal adverse events.
Long-Term Outcomes
A long-term study involving 466 hypertensive patients compared lisinopril monotherapy with a combination of lisinopril and the thiazide diuretic trichlormethiazide. Both treatment regimens effectively lowered blood pressure, but the combination therapy allowed for a lower maintenance dose of lisinopril and mitigated the increase in serum potassium observed with lisinopril monotherapy.
Conclusion
Lisinopril is an effective antihypertensive agent with favorable metabolic and rheological profiles compared to hydrochlorothiazide. It can be used as monotherapy or in combination with diuretics to enhance blood pressure control and improve patient outcomes. The choice between lisinopril and diuretics should consider individual patient characteristics, including metabolic risk factors and the need for long-term management of hypertension and heart failure.
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