Quinapril vs lisinopril comparison
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Antihypertensive Efficacy: Quinapril vs Lisinopril
Both quinapril and lisinopril are effective in lowering blood pressure in patients with mild to moderate hypertension. Several studies show that both drugs significantly reduce systolic and diastolic blood pressure, but the degree and consistency of control can differ. Some research found that quinapril led to a greater reduction in blood pressure and heart rate at certain time points, particularly at week 4 and week 8 of treatment, compared to lisinopril . However, other studies using ambulatory blood pressure monitoring (ABPM) found that lisinopril provided a more significant and sustained reduction in blood pressure over 24 hours, with a higher percentage of patients achieving controlled hypertension compared to quinapril 234. In elderly patients with low plasma renin, both drugs were effective, but quinapril provided more consistent blood pressure control .
Dosing and Duration of Action
Both medications are typically administered once daily. However, some studies noted that quinapril may not maintain blood pressure control as effectively as lisinopril 12 hours after dosing, suggesting that lisinopril may offer more stable 24-hour coverage . Dose adjustments may be necessary if blood pressure is not adequately controlled after initial therapy .
Safety, Tolerability, and Side Effects
Both quinapril and lisinopril are generally well tolerated, with similar side effect profiles. Common side effects include cough, hyperkalemia, and potential kidney issues, with rare but serious risks such as angioedema . Both drugs can cause a significant increase in serum potassium, but no significant differences in other laboratory parameters were observed between the two . In terms of liver toxicity, lisinopril showed no evidence of cytotoxicity in rat hepatocyte studies, while quinapril demonstrated higher cytotoxicity, especially when cytochrome P450 enzymes were induced .
Pharmacodynamics and Tissue Effects
Quinapril and lisinopril differ in their tissue distribution and potency. Quinaprilat, the active form of quinapril, has a higher affinity for tissue ACE compared to lisinopril, which may contribute to its effects on heart rate and autonomic balance 78. Quinapril also shows prolonged tissue ACE inhibition in organs like the lung, kidney, and heart, but does not cross the blood-brain barrier as some other ACE inhibitors do .
Cost and Availability
Lisinopril is generally more affordable and widely available compared to quinapril, which may not be accessible in all regions . This can influence the choice of therapy, especially in settings where cost is a significant consideration.
Additional Biochemical Effects
Both drugs can lower cholesterol levels, with quinapril also reducing LDL cholesterol and basal glycemia in some patients 34. In laboratory studies, lisinopril showed stronger inhibition of carbonic anhydrase enzymes than quinapril, which may have implications for future drug development .
Conclusion
Quinapril and lisinopril are both effective ACE inhibitors for treating mild to moderate hypertension, with similar safety profiles. Lisinopril may provide more consistent 24-hour blood pressure control and is more cost-effective, while quinapril may offer greater reductions in blood pressure and heart rate at certain time points and in specific patient populations. The choice between the two should consider individual patient response, tolerability, cost, and availability 12345789+1 MORE.
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