Long term side effects of lisinopril
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Long-Term Side Effects of Lisinopril
Common Adverse Effects in Hypertensive Patients
Lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, is widely used for treating hypertension and congestive heart failure (CHF). In hypertensive patients, the most frequently reported side effects include headache, dizziness, cough, nausea, diarrhea, and fatigue. However, not all these events are directly related to lisinopril. Approximately 6.1% of patients discontinued the medication due to adverse effects, with cough and nausea being the most common reasons .
Side Effects in Congestive Heart Failure Patients
In patients with CHF, the most common adverse effects reported were dizziness, dyspnea, diarrhea, hypotension, and fatigue. Therapy was discontinued in 9.6% of these patients, primarily due to hypotension, dizziness, diarrhea, and rash. Notably, 9.1% of CHF patients died during the study, with three deaths considered related to lisinopril therapy .
Hemodynamic and Renal Effects
Lisinopril has been shown to produce significant hemodynamic changes, including reductions in systemic arterial pressure, pulmonary artery wedge pressure, and systemic vascular resistance, along with increases in cardiac index and stroke volume index. These effects persist with long-term use, although the increases in cardiac index and stroke volume index may not remain statistically significant over time 56. Additionally, some patients may experience renal dysfunction, which can often be managed by adjusting the dosage of lisinopril or accompanying diuretics .
Impact on Diabetic Nephropathy
In patients with diabetic nephropathy, long-term treatment with lisinopril has shown beneficial effects on kidney function. A study comparing lisinopril with nisoldipine found that lisinopril significantly reduced albuminuria, a marker of kidney damage, although the overall decline in glomerular filtration rate (GFR) was similar between the two drugs over a four-year period . Another study indicated that combining lisinopril with telmisartan provided superior blood pressure and albumin excretion rate control compared to monotherapy, suggesting a potential approach for preventing diabetic nephropathy .
Safety in Renal Transplant Patients
In hypertensive renal transplant recipients treated with cyclosporin, lisinopril was compared with nifedipine. Both drugs were effective in managing hypertension, but nifedipine showed a more significant improvement in renal graft function over two years . This suggests that while lisinopril is safe, it may not be the optimal choice for preserving renal function in this patient population.
Long-Term Tolerability
Long-term studies have confirmed that lisinopril is generally well tolerated. In a large cohort of CHF patients, 33.1% discontinued treatment over a four-year period, with 33% of these discontinuations due to clinical adverse events. The most common laboratory abnormalities included increases in blood urea nitrogen, serum creatinine, and plasma potassium levels. Elderly patients and those with severe heart failure were at a higher risk for adverse events .
Conclusion
Lisinopril is an effective and generally well-tolerated medication for managing hypertension and CHF. Common side effects include headache, dizziness, cough, and nausea, with a small percentage of patients discontinuing due to these adverse effects. Long-term use can lead to significant hemodynamic benefits and renal protection, particularly in diabetic patients, although careful monitoring is required to manage potential renal dysfunction and other adverse events.
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