Lisinopril prinivil
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Lisinopril (Prinivil): A Comprehensive Overview
Introduction to Lisinopril (Prinivil)
Lisinopril, commonly known by its brand names Prinivil, Qbrelis, and Zestril, is an angiotensin-converting enzyme (ACE) inhibitor. This class of drugs is primarily used to treat high blood pressure (hypertension), protect kidney function in diabetic patients, and reduce the risk of death following a heart attack1. Lisinopril is also available in combination with the diuretic hydrochlorothiazide under the brand name Zestoretic1.
Mechanism of Action
Lisinopril works by inhibiting the angiotensin-converting enzyme, which plays a crucial role in the renin-angiotensin-aldosterone system (RAAS). This inhibition prevents the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, thereby leading to the relaxation of blood vessels and a subsequent decrease in blood pressure3. The crystal structure of the human ACE-lisinopril complex has provided insights into the drug's binding mechanism, which is essential for designing more selective ACE inhibitors3.
Clinical Efficacy in Hypertension
Lisinopril has been shown to be effective in reducing both systolic and diastolic blood pressure in patients with essential hypertension. In a study involving 20 patients, a significant reduction in blood pressure was observed after six weeks of treatment with lisinopril, with further improvements noted upon increasing the dose2. This highlights the drug's efficacy in managing hypertension, even in cases requiring dose adjustments.
Metabolic Effects
Lisinopril not only lowers blood pressure but also has beneficial effects on glucose metabolism. In patients with impaired glucose tolerance, lisinopril treatment resulted in a significant reduction in blood sugar levels and immunoreactive insulin levels after 12 weeks2. Additionally, it has been shown to modulate hyperinsulinemia and reduce adrenaline levels, which are often elevated in hypertensive patients4. These findings suggest that lisinopril may offer metabolic benefits beyond its primary antihypertensive action.
Effects on Renal Function
The impact of lisinopril on renal function varies with age. In a study comparing elderly and young individuals, it was found that while young subjects experienced increased sodium excretion and glomerular filtration rates, elderly subjects did not show these changes. Instead, diuresis decreased in the elderly, indicating that the aged kidney responds differently to ACE inhibition5. This underscores the need for careful monitoring of renal function in elderly patients on lisinopril.
Humoral Factors and Blood Pressure Regulation
Lisinopril has been shown to influence various humoral factors involved in blood pressure regulation. In hypertensive patients, treatment with lisinopril increased atrial natriuretic factor (ANF) levels and decreased endothelin levels, which may contribute to its blood pressure-lowering effects7. These changes suggest that lisinopril helps to restore a balance between vasoconstrictive and vasodilative substances in the body.
Safety and Side Effects
While lisinopril is generally well-tolerated, it can cause side effects such as increased potassium levels, elevated creatinine, and a persistent cough. Rarely, it may lead to angioedema, a serious condition characterized by swelling of the deeper layers of the skin8. It is important to monitor patients for these potential adverse effects, especially when initiating therapy or adjusting doses.
Conclusion
Lisinopril (Prinivil) is a versatile and effective ACE inhibitor used primarily for managing hypertension, protecting renal function in diabetic patients, and reducing mortality post-heart attack. Its benefits extend beyond blood pressure control, offering positive effects on glucose metabolism and humoral factors. However, careful monitoring is essential, particularly in elderly patients and those at risk of adverse effects. Overall, lisinopril remains a cornerstone in the treatment of cardiovascular and renal conditions.
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Lisinopril
Lisinopril is a prescription drug used to treat high blood pressure, protect kidneys in diabetes, and reduce the risk of death during a heart attack.
[Lisinopril in the monotherapy of patients with essential hypertension: the effect of therapy on glucose and lipid metabolism].
Lisinopril effectively reduces blood pressure and improves glucose metabolism in patients with essential hypertension, without significant side-effects.
Non-RCTCrystal structure of the human angiotensin-converting enzyme–lisinopril complex
The crystal structure of human ACE reveals its little similarity to carboxypeptidase A, offering potential for designing domain-selective ACE inhibitors with new pharmacological profiles.
Highly Cited[Control of hyperinsulinemia in essential hypertension using the angiotensin-converting enzyme inhibitor, lisinopril].
Lisinopril therapy, in addition to its antihypertensive effect, may also favorably modulate some pathogenic and metabolic factors in essential hypertension.
Non-RCTLisinopril has no natriuretic effect in elderly: A study of the single-dose response in aged vs young individuals
Lisinopril has no natriuretic effect in elderly individuals, suggesting that their kidneys react differently to ACE inhibition, potentially leading to sodium retention.
Non-RCT[Changes in humoral pressor and depressor factors in essential hypertension during lisinopril therapy].
Lisinopril treatment effectively reduces blood pressure and improves blood pressure regulation in essential hypertensive patients without significantly altering other humoral factors.
Non-RCTPlasma concentrations of some cardiovascular humoral factors in essential hypertension and their changes during the treatment with converting enzyme inhibitor lisinopril.
Essential hypertension may be linked to a predominance of vasoconstrictor endothelin, and lisinopril treatment may reverse this imbalance, contributing to blood pressure reduction.
Non-RCTHypertension management.
Hypertension management in patients with Chronic Kidney Disease can be managed with ACE inhibitors and ARBs, but may require monitoring for side effects and adjusting doses.
Angiotensin-converting enzyme inhibitors.
ACE inhibitors are effective in treating hypertension and congestive heart failure, and may slow internal hyperplasia rates.
Tablet Splitting—Only If You “Half” To.
Vol. 35 No. 2 • February 2010 • P&T® 69 A woman was admitted to the hospital with unstable angina and hypertension. Her physician found that she had been taking the wrong dose of lisinopril (Prinivil, Merck; Zestril, AstraZeneca). She was supposed to be taking 5 mg twice daily, but the prescription label listed 10-mg tablets in the bottle. When the physician looked inside, he saw both pink and peach tablets, some split in half. Initially, the patient had been taking a 20-mg tablet twice daily. When the physician lowered the dose to 10 mg twice daily, the new prescription was filled. The patient then cut the leftover 20-mg tablets in half and put them in the same bottle that held the 10-mg tablets. Later, the physician lowered the dose to 5 mg twice daily. Instead of filling the new prescription for 5-mg tablets, she tried to find all the 10-mg tablets to split them in half, but some remained whole. In this case, no one could be certain of the dose the patient had been taking before she was hospitalized.
Case Report