Lisinopril od
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Lisinopril Once Daily (OD): Efficacy, Safety, and Clinical Applications
Introduction to Lisinopril OD
Lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, is widely used for treating hypertension and chronic heart failure (CHF). It is often prescribed once daily (OD) due to its long-acting nature. This article synthesizes research findings on the efficacy, safety, and clinical applications of lisinopril OD.
Efficacy of Lisinopril in Chronic Heart Failure
High-Dose vs. Low-Dose Lisinopril in CHF
The ATLAS trial investigated the safety and tolerability of high-dose versus low-dose lisinopril in patients with CHF. The study found that high doses (35.0 or 32.5 mg OD) were generally well-tolerated and could be titrated successfully in most patients. High-dose lisinopril significantly reduced mortality and morbidity compared to low doses (5.0 or 2.5 mg OD), suggesting that more aggressive use of ACE inhibitors is warranted in CHF management.
Lisinopril in Hypertension Management
Comparative Efficacy with Hydrochlorothiazide
A multicenter study compared the antihypertensive effects of lisinopril, hydrochlorothiazide (HCTZ), and their combination. Lisinopril alone (20-80 mg OD) was more effective in reducing blood pressure than HCTZ alone (12.5-50 mg OD). The combination therapy of lisinopril and HCTZ showed even greater efficacy, indicating that lisinopril is a potent antihypertensive agent both as monotherapy and in combination.
Pediatric Hypertension
Lisinopril is also used in pediatric hypertension, although it is off-label for children under six years. A study on hypertensive children and adolescents found that lisinopril's pharmacokinetics were influenced by body weight and kidney function. The study recommended dose adjustments based on estimated glomerular filtration rate (eGFR) and body weight to optimize treatment outcomes.
Safety and Tolerability
Adverse Events and Tolerability in CHF
In the ATLAS trial, adverse events such as hypotension and renal dysfunction were relatively rare, even at high doses. The study reported that only 4.2% of patients could not be titrated to medium doses due to these symptoms. Withdrawal rates were similar between high-dose (27.1%) and low-dose (30.7%) groups, indicating good overall tolerability.
Safety in Acute Myocardial Infarction
The GISSI-3 trial assessed lisinopril's safety and efficacy in patients with acute myocardial infarction (AMI). Lisinopril significantly reduced six-week mortality and improved ventricular function when started within 24 hours of symptom onset. The combination of lisinopril and transdermal glyceryl trinitrate (GTN) also showed significant benefits without increasing adverse events.
Pharmacogenomics and Personalized Medicine
ACE Gene Polymorphism
The EURODIAB Controlled Trial of Lisinopril in IDDM explored the impact of ACE gene polymorphism on renal disease progression in diabetic patients. The study found that patients with the II genotype had a faster rate of albumin excretion rate (AER) progression on placebo but responded better to lisinopril treatment. This suggests that ACE genotype may help predict the efficacy of lisinopril in preventing renal disease progression.
Conclusion
Lisinopril OD is a highly effective and generally well-tolerated treatment for hypertension and CHF. High doses can be safely administered in most patients, providing significant benefits in reducing mortality and morbidity. Its efficacy extends to pediatric hypertension and acute myocardial infarction, with pharmacogenomic insights offering potential for personalized treatment strategies. Overall, lisinopril remains a cornerstone in cardiovascular disease management.
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