COMPARISON OF 24-HOUR BLOOD-PRESSURE RHYTHMS DURING THERAPY OF HEART-FAILURE WITH LISINOPRIL AND CAPTOPRIL

When treating patients with heart failure a long plasma half life of ACE inhibitors used may be advantageous. Therefore, lisinopril, an ACE-inhibitor with a long plasma half life, was compared with the short acting captopril. 28 patients with heart failure (NYHA II-IV) were randomized to either 10 mg lisinopril once daily or captopril 12,5 mg three times daily. Blood pressure was measured by the oscillometric method with a SpaceLabs blood pressure monitor for 24 hours before and after the titration period (after 5 days). Before initiation of ACE inhibition age, the severity of heart failure, renal function and plasma-renin-activity were not different between the captopril (C) and lisinopril (L) group. A similar circadian blood pressure rhythm with blood pressure amplitudes of 6-9 mmHg was present in both groups. The mesor of blood pressure at baseline was 118 +/- 0.7/75 +/- 0.4 mmHg (C) and 121 +/- 0.6/73 +/- 0.7 mmHg (L) (n.s.). Both ACE inhibitors caused a significant decrease of the 24-hour mean of blood pressure with a tendency to greater decreases in the lisinopril group (8.7 +/- 2.4 mmHg vs. 5.4 +/- 2.1 mmHg). However, the circadian rhythm of blood pressure was preserved in both groups during ACE inhibition. The increases in plasma-renin-activity were comparable in both groups. In conclusion, low doses of lisinopril once daily and low doses of captopril given three times daily caused similar changes in blood pressure without altering the circadian blood pressure rhythm significantly.