Lisinopril withdrawal
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Lisinopril Withdrawal: Effects and Considerations
Introduction to Lisinopril Withdrawal
Lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, is commonly prescribed for conditions such as hypertension, heart failure, and post-myocardial infarction management. Understanding the effects of withdrawing lisinopril is crucial for optimizing patient outcomes and managing potential risks.
Impact on Mortality and Ventricular Function Post-Myocardial Infarction
Early Treatment Benefits
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. This benefit persists even after the treatment is withdrawn at six weeks 12. Specifically, at six months, 18.1% of patients who received lisinopril died or developed severe ventricular dysfunction compared to 19.3% in the control group, demonstrating a lasting positive effect on prognosis 12.
Long-Term Effects on Left Ventricular Structure
Further analysis from the GISSI-3 trial shows that lisinopril treatment reduces left ventricular dilatation, particularly in patients with significant wall motion asynergy. This structural benefit is maintained even after the withdrawal of lisinopril, suggesting that early intervention can have enduring effects on heart structure and function .
Lisinopril Withdrawal in Heart Failure Management
Feasibility of Diuretic Discontinuation
A study on patients with stable congestive heart failure (CHF) explored the feasibility of discontinuing diuretic therapy while continuing lisinopril. Results indicated that 29% of patients did not require reinitiation of diuretics, highlighting that lisinopril can help maintain stability in certain CHF patients even after diuretic withdrawal . However, factors such as a higher baseline furosemide dose, lower ejection fraction, and history of hypertension were predictive of the need to restart diuretics .
Effects on Hypertension and Cardiac Autonomic Control
Blood Pressure Management in Children
In hypertensive children, lisinopril has been shown to effectively lower blood pressure in a dose-dependent manner. Upon withdrawal, blood pressure increased, indicating the necessity of continued treatment for sustained blood pressure control .
Cardiac Autonomic Control
In hypertensive patients with left ventricular hypertrophy, lisinopril treatment improved cardiac autonomic control, as evidenced by increased heart period variability. However, these benefits were reversed upon drug withdrawal, underscoring the importance of ongoing treatment for maintaining autonomic balance .
Conclusion
The withdrawal of lisinopril can have varied effects depending on the condition being treated. In post-MI patients, early lisinopril treatment offers lasting benefits on mortality and ventricular function. For CHF patients, lisinopril can support stability even after diuretic withdrawal, though certain risk factors may necessitate reinitiation. In hypertensive patients, particularly children, and those with left ventricular hypertrophy, continuous lisinopril treatment is crucial for sustained blood pressure control and cardiac autonomic function. These findings highlight the importance of careful management and monitoring when considering the withdrawal of lisinopril.
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