Lisinopril vs enalapril
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These studies suggest that lisinopril and enalapril are similarly effective and well-tolerated for treating mild-to-moderate heart failure and hypertension, with lisinopril showing a more prominent reduction in systolic blood pressure, while enalapril may improve arterial endothelial function and cognitive functions more effectively.
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Comparative Analysis of Lisinopril vs Enalapril
Introduction to ACE Inhibitors: Lisinopril and Enalapril
Lisinopril and enalapril are both angiotensin-converting enzyme (ACE) inhibitors commonly used to treat conditions such as hypertension and heart failure. Despite their similar mechanisms of action, there are notable differences in their pharmacological profiles and clinical effects.
Efficacy in Heart Failure Treatment
A study comparing lisinopril and enalapril in patients with mild-to-moderate heart failure found that both drugs significantly improved exercise capacity and symptoms of heart failure over a 12-week period. There was a trend towards a greater increase in exercise duration with lisinopril, although this did not reach statistical significance. Both drugs were equally effective in improving New York Heart Association (NYHA) grading and symptoms, and were well tolerated with similar adverse event profiles.
Blood Pressure Reduction in Hypertension
Several studies have compared the antihypertensive efficacy of lisinopril and enalapril. Both drugs significantly reduced office and ambulatory blood pressure (ABP) values in patients with mild-to-moderate hypertension. Lisinopril showed a more prominent reduction in systolic blood pressure (SBP) in some studies, particularly in office SBP, 24-hour SBP load, and nighttime SBP load . However, another study indicated that both drugs had similar and significant reductions in systolic and diastolic blood pressure over a 24-hour period.
Endothelial Function and Lipophilicity
Enalapril has been shown to improve arterial endothelial function, as measured by flow-mediated dilation (FMD), whereas lisinopril did not demonstrate such an effect. This difference is attributed to the lipophilicity of enalapril, which allows it to improve endothelial function more effectively than the hydrophilic lisinopril. The blood-pressure-lowering effects of both drugs were independent of their lipophilicity.
Cognitive Effects
Lisinopril, which crosses the blood-brain barrier, was found to have a significant negative effect on certain cognitive functions, including perceptual motor skills, complex attention, and learning. In contrast, enalapril, which does not cross the blood-brain barrier, was more successful in improving cognitive functions.
Pharmacokinetics and Renal Function
In patients with chronic renal insufficiency, both lisinopril and enalapril showed significant increases in serum concentrations over time. However, lisinopril exhibited greater accumulation compared to enalapril. Both drugs were effectively cleared by hemodialysis, which significantly reduced their plasma concentrations .
Hemodynamic Effects
Both lisinopril and enalapril were found to have significant and identical hypotensive effects without affecting the diurnal rhythm of blood pressure or heart rate. Lisinopril was more effective in inhibiting ACE activity, although this did not translate into a greater hypotensive effect.
Conclusion
Lisinopril and enalapril are both effective ACE inhibitors for treating hypertension and heart failure. While lisinopril may offer a slight advantage in reducing systolic blood pressure, enalapril has a superior effect on endothelial function and cognitive outcomes. Both drugs are well tolerated and have similar safety profiles, making them viable options depending on the specific clinical needs of the patient.
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