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European Journal of Heart Failure 2000 2(3):299-304; doi:10.1016/S1388-9842(00)00095-7
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© 2000 European Society of Cardiology

First-dose hypotension after angiotensin-converting enzyme (ACE) inhibitors in chronic heart failure: a comparison of enalapril and perindopril

Jirí Vítovec*, Jindrich Spinar and Czech and Slovak Investigator Group1

2nd Department of Medicine, St. Anne's University Hospital, Masaryk University Pekarska 53, 656 91 Brno, Czech Republic

* Corresponding author. Tel.: +420-5-4318-2287; fax: +420-5-4318-2287. E-mail address: jvitovec{at}med.muni.cz (J. Vítovec).


  Abstract

Background: First-dose hypotension refers to an observed reduction in blood pressure after the administration of the first dose of ACE inhibitors in patients with congestive heart failure.

Aim: To compare the first-dose responses of low-dose enalapril and perindopril in patients with stable symptomatic chronic heart failure.

Methods: Single blind, randomised, multicenter, parallel, prospective study. Patients (N = 298) with chronic heart failure due to ischemic heart disease or dilated cardiomyopathy, NYHA II–IV, ejection fraction < 40%, age > 18 years, naive to ACE inhibitors or ATI-receptor blocker, were randomised to receive a single dose of 2.5 mg enalapril or 2.0 mg perindopril. Baseline laboratory and clinical examinations were performed before entry into the study. Ambulatory blood pressure monitoring started 2 h before the study medication was given, and continued for at least 10 h after the medication.

Results: The maximum drop in blood pressure appeared approximately 4 h after dose administration in both groups, and was more pronounced in the enalapril group. Patients in the enalapril group had a significantly higher incidence of asymptomatic hypotension. No symptomatic hypotension requiring a change in medication or a prolongation of hospitalisation was observed.

Conclusion: A low dose of perindopril is well-tolerated at initiation of ACE inhibitor therapy in patients with chronic heart failure and causes less first-dose hypotension than a low dose of enalapril.

Key Words: Hypotension • Congestive heart failure • Enalapril • Perindopril

Received October 11, 1999; Revised April 10, 2000; Accepted May 23, 2000

1 Investigator Study Group of the Czech Republic: Jirí Vítovec, MD; Jindrich Spinar, MD; Lea Kubecová, MD; Rostislav Stríbrny, MD; Ilja Kotík, MD; Pavel Prazák, MD; Miloslav Pech, MD; Karel Kubát, MD; and Petr Vymétal MD; and the Investigator Study Group of the Slovak Republic: Ján Murlín, MD; Miroslav Szentiványi, MD; Jozef Gonsorcík, MD; and Michal Ryník, MD.


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