Hypertension lisinopril

Chemotherapy with 7+3 (cytarabine for 7 days + idarubicin for 3 days) is ordered for HT. You also determine that HT is taking lisinopril 10 mg by mouth daily for hypertension. 

All 10 ACE inhibitors available in the United States can be dosed once daily for hypertension except captopril, which is usually dosed two or three times daily. The absorption of captopril (but not enalapril or lisinopril) is reduced by 30% to 40% when given with food. 

Captopril (Capoten ), Enalapril and Lisinopril (Fig. 13) are examples of ACE inhibitors that are rather successful as pharmaceutical drugs against hypertension. In most cases these inhibitors are bound via zinc binding groups (ZBGs) such as thiolates, carboxylates or hydroxamates to the zinc(II) center of the active site. 

Hyperkaiemia Elevated serum potassium (at least 0.5 mEq/L greater than the upper limit of normal) was observed in 0.4% of hypertensive patients given trandolapril, approximately 1% of hypertensive patients given benazepril, enalapril, ramipril, or moexipril approximately 2% of patients receiving quinapril or lisinopril, approximately 2.6% of hypertensive patients given fosinopril, and approximately 4.8% of CHF patients given lisinopril. Hyperkalemia also occurred with captopril. Vaivuiar stenosis Theoretically, patients with aortic stenosis might be at risk of decreased coronary perfusion when treated with vasodilators, because they do not develop as much afterload reduction as others. 

While essentially all ACE inhibitors have a similar mechanism of action and therefore exhibit similar efficacy in the treatment of hypertension and congestive heart failure, these drugs differ slightly in their pharmacokinetic profiles. Enalapril, lisinopril, and quinapril are excreted primarily by the kidney, with minimal liver metabolism, while the other prodrug compounds are metabolized by the liver and renally excreted. Thus, in patients with renal insufficiency, the half-life of renally excreted ACE inhibitors is prolonged. In addition, patients with impaired liver func-... 

Enalapril is an oral prodrug that is converted by hydrolysis to a converting enzyme inhibitor, enalaprilat, with effects similar to those of captopril. Enalaprilat itself is available only for intravenous use, primarily for hypertensive emergencies. Lisinopril is a lysine derivative of enalaprilat. Benazepril, fosinopril, moexipril, perindopril, quinapril, ramipril, and trandolapril are other long-acting members of the class. All are prodrugs, like enalapril, and are converted to the active agents by hydrolysis, primarily in the liver. 

A 30-year-old white man with hypertension, type 1 diabetes mellitus, and hyperlipidemia developed myalgias, nausea, and vomiting, which began 4 days after he started working as a jackhammer operator (52). His medications were lisinopril, aspirin, insulin, and gemfibrozil. Creatine kinase and creatinine, which had previously been respectively mildly raised and normal, were markedly raised, consistent with rhabdomyolysis with acute renal insufficiency. 

A 76-year-old woman taking lisinopril 20 mg/day and metoprolol for hypertension developed headaches, nausea, and a tingling sensation in her arms. Her serum sodium was 109 mmol/1, with a serum osmolality of 225 mosm/kg, urine osmolality of 414 mosm/kg, and urine sodium of 122 mmol/1. She had taken diclofenac 75 mg/day for arthritic pain for 6 years and naproxen for about 1 month. Propoxyphene napsylate and paracetamol had then been substituted and zolpidem had been started. A diagnosis of SIADH was postulated and thyroid and adrenal causes were excluded. Lisinopril was withdrawn and fluid was restricted to 100 ml/day. The serum sodium gradually corrected to 143 mmol/1. 

Spontaneously hypertensive (SH) rats had higher (by 6%) blood plasma TAC than normal animals TAC correlated negatively with blood pressure in normal but not in hypertensive rats (N4). Other authors found no differences in TAC of blood plasma of SH rats as compared with normotensive rats. Lisinopril or amlodipine treatment did not affect TAC (M5). Another study found a negative correlation of TAC with blood pressure in normal but not SH rats (N5). 

A 39-year-old man with schizophrenia and diabetes, who had taken clozapine 300 mg/day and glipizide 10 mg/day for a year, took lisinopril 5 mg/day for newly diagnosed hypertension. On several occasions afterwards he had roughly a doubling of his blood concentrations of clozapine and norclozapine. He had typical effects of clozapine toxicity. After replacement of lisinopril by diltiazem, the blood concentrations of clozapine and norclozapine returned to the values that were present before lisinopril was introduced. 

The blood pressure of a 59-year-old man with hypertension and normal renal function rose when rofecoxib 25 mg/day was added to lisinopril 10 mg/day (from an average of 135/80-85 to 168/98 mmHg within 5 weeks). Four days after rofecoxib was withdrawn the blood pressure was 127/78 mmHg. Rechallenge with the same dose of rofecoxib produced the same effect and the blood pressure fell when the dosage of lisinopril was increased to 20 mg/day on continuous rofecoxib. The authors did not report on the course of renal function. 

In the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), over 40 000 participants aged 55 years or older with hypertension and at least one other risk factor for coronary heart disease were randomized to chlortalidone, amlodipine, doxazosin, or lisinopril (1,2). Doxazosin was discontinued prematurely because chlortalidone was clearly superior in preventing cardiovascular events, particularly heart failure (2). Otherwise, mean follow-up was 4.9 years. There were no differences between chlortalidone, amlodipine, and lisinopril in the primary combined outcome or allcause mortality. Compared with chlortalidone, heart failure was more common with amlodipine and lisinopril, and chlortalidone was better than lisinopril at preventing stroke. 

Brilla CG, Matsubara L, Weber KT. Advanced hypertensive heart disease in spontaneously hypertensive rats. Lisinopril-mediated regression of myocardial fibrosis. Hypertension 1996 28(2) 269-75. 

Brilla CG, Funck RC, Rupp H. Lisinopril-mediated regression of myocardial fibrosis in patients with hypertensive heart disease. Circulation 2000 102(12) 1388-93. 

Lisinopril is a non-sulfhydryl ACE inhibitor. It has been used in patients with hypertension, heart failure, myocardial infarction, and diabetic nephropathy. 

Lisinopril 20 mg/day has been compared with atenolol 100 mg/day in a 16-week, double-blind, randomized, controlled trial in 90 hypertensive men aged 40-49 and without a history of sexual dysfunction. The number of occasions on which they had sexual intercourse fell during the first month in both groups (9). Subsequently, sexual activity tended to recover with Usinopril but not atenolol. The authors suggested that lisinopril may cause only a temporary reduction in sexual function. 

A 39-year-old man with schizophrema and diabetes, who had taken clozapine 300 mg/day and glipizide 10 mg/day for a year, took lisinopril 5 mg/day for newly diagnosed hypertension. On several occasions... 

A 10-year-old boy developed hypotension and reduced alertness. His blood pressure was 56/24 mmHg and his heart rate 88/minute. He had a history of a hypoxic ischemic insult to the central nervous system, subsequent hypertension, and spastic quadriplegia. His blood pressure had been controlled for the last 10 months with lisinopril (dose not stated). Tizanidine had been added 1 week before admission for spasticity. Lisinopril and tizanidine were withdrawn and his blood pressure rose to 149/89 mmHg over the next day. He was discharged and lisinopril was restarted but not tizanidine. He had no further problems with hypotension. 

A 60-year-old woman, with a history of hypertension, type 2 diabetes mellitus, and depression, took clomipramine 200 mg/day for 8 months and then 250 mg/day for 3 months. Her other medications were glibenclamide 7.5 mg/day, lisinopril 5 mg/day, and clonazepam 0.5 mg/day. Without any change in medications or other precipitants, she began to feel confused and weak. She became pyrexial (41.6°C), confused, and... 

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