Document Detail


Factors determining the response to angiotensin-converting enzyme inhibitors in hypertension.
MedLine Citation:
PMID:  2257718     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Converting enzyme inhibitors, alone or in combination, are a safe and effective treatment for many hypertensives. However, the range of responses varies between individual patients and it has been claimed that there are two or three phases to the response. Pretreatment plasma renin (as an indication of activation of the renin angiotensin system) and the patient's age have been claimed to predict blood pressure fall. We have investigated whether these factors are useful indications of clinical response in mild-moderate essential hypertension. We have also investigated how well the response to the first dose correlates with the response to long-term (6 weeks) treatment. In a placebo-controlled trial of enalapril (20 mg daily), the blood pressure fall was analysed using an integrated pharmacokinetic/dynamic model of the concentration-effect relationship. The relation between the active drug concentration and blood pressure fall was best described by a non-linear Langmuir (Emax) model: E = (Emax C/C50 + C), where E is the effect, C the drug concentration, Emax is the maximum blood pressure fall and C50 is the drug concentration which causes a fall in blood pressure of 50% of the maximum. For a group of 13 essential hypertensives Emax was 46/20 mm Hg and C50 77 +/- 17 ng/ml. Emax was not related to age or pretreatment renin, but was positively correlated with pretreatment blood pressure (r = 0.69; p less than 0.01). Emax after 6 weeks of treatment (48 +/- 22 and 50 +/- 20 mm Hg, respectively, r = 0.89; p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
Authors:
J L Reid; R Donnelly; H L Elliott; P A Meredith
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Publication Detail:
Type:  Clinical Trial; Journal Article; Review    
Journal Detail:
Title:  Clinical physiology and biochemistry     Volume:  8 Suppl 1     ISSN:  0252-1164     ISO Abbreviation:  Clin Physiol Biochem     Publication Date:  1990  
Date Detail:
Created Date:  1991-01-31     Completed Date:  1991-01-31     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  8305885     Medline TA:  Clin Physiol Biochem     Country:  SWITZERLAND    
Other Details:
Languages:  eng     Pagination:  1-5     Citation Subset:  IM    
Affiliation:
Department of Materia Medica, University of Glasgow, Scotland, UK.
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Angiotensin-Converting Enzyme Inhibitors / administration & dosage,  therapeutic use*
Blood Pressure / drug effects
Humans
Hypertension / blood,  drug therapy*,  physiopathology
Renin / blood
Chemical
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; EC 3.4.23.15/Renin

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