Clinical Drug Investigation

, Volume 20, Issue 1, pp 19–24

Moxonidine and Ramipril in Patients with Hypertension and Obstructive Pulmonary Disease

  • Martin Feuring
  • Werner Cassel
  • Barbara Thun
  • Ludger Grote
  • Martin Wehling
  • Thomas Penzel
  • Joerg Hermann Peter
Clinical Use


Objectives: To investigate the tolerability and efficacy of moxonidine in the treatment of arterial hypertension in patients with obstructive pulmonary disease. The ACE inhibitor ramipril was used as a reference agent.

Patients and Methods: A group of 104 adult patients with arterial hypertension and respiratory disorders took part in a double-blind, randomised, parallel-group, single-centre study. During the eight-week treatment phase, patients received either moxonidine (0.2 or 0.4 mg/day) or the ACE inhibitor ramipril (2.5 or 5 mg/day).

Results: Small, nonsignificant changes in arterial oxygen partial pressure (PaO2) were observed during the treatment period with both moxonidine and ramipril. Forced expiratory volume in one second (FEV1) remained constant during treatment with moxonidine. A slight decrease in FEV1 with ramipril was not statistically significant (p > 0.1). The 24-hour blood pressure measurements showed that systolic and diastolic blood pressures were reduced with moxonidine (p = 0.018 and p = 0.009, respectively) and with ramipril (p < 0.001 for both measurements).

Conclusions: Moxonidine and ramipril exhibited comparable antihypertensive efficacy. Lung function was unchanged during treatment with moxonidine, suggesting that this new antihypertensive agent may be an appropriate choice of medication for patients with essential hypertension and concomitant obstructive pulmonary disease.


  1. 1.
    Kaplan NM. Hypertension in the population at large. In: Kaplan NM, editor. Clinical hypertension, Baltimore: Williams & Wilkens, 1994: 1–22Google Scholar
  2. 2.
    Mannino DM, Gagnon RC, Petty TL, et al. Obstructive lung disease and low lung function in adults in the United States: data from the National Health and Nutrition Examination Survey, 1988–1994. Arch Intern Med 2000; 160: 1683–9PubMedCrossRefGoogle Scholar
  3. 3.
    Gulsvik A. Mortality in and prevalence of chronic obstructive pulmonary disease in different parts of Europe. Monaldi Arch Chest Dis 1999; 54: 160–2PubMedGoogle Scholar
  4. 4.
    Prichard BNC. Clinical experience with moxonidine. Cardiovasc Drugs Ther 1994; 8Suppl. 1: 49–58PubMedCrossRefGoogle Scholar
  5. 5.
    Ernsberger P, Damon TH, Graff LM, et al. Moxonidine, a centrally acting antihypertensive agent, is a selective ligand for I1-imidazoline sites. J Pharmacol Exp Ther 1993; 264: 172–82PubMedGoogle Scholar
  6. 6.
    Ernsberger P, Haxhiu MA, Graff LM, et al. A novel mechanism of action for hypertension control: moxonidine as a selective I1-imidazoline agonist. Cardiovasc Drugs Ther 1994; 8Suppl. 1: 27–41PubMedCrossRefGoogle Scholar
  7. 7.
    Haxhiu MA, Dreshaj I, Schafer SG, et al. Selective antihypertensive action of moxonidine is mediated mainly by I1-imidazoline receptors in the rostral ventrolateral medulla. J Cardiovasc Pharmacol 1994; 24Suppl. 1: 1–8CrossRefGoogle Scholar
  8. 8.
    Ernsberger P. The I1-imidazoline receptor agonist moxonidine: molecular, cellular and organismic actions. Rev Contemp Pharmacother 1998; 9: 441–62Google Scholar
  9. 9.
    McNeill RS. Effects of a beta-adrenergic-blocking agent, propranolol, on asthmatics. Lancet 1984; II: 1101–2Google Scholar
  10. 10.
    Geefhorst APM, van Herwaarden CLA. Comparative study of the ventilatory effects of three beta-selective blocking agents in asthmatic patients. Eur J Clin Pharmacol 1981; 20: 417–21CrossRefGoogle Scholar
  11. 11.
    Wilkens H, Wilkens JH, Hecht M, et al. Effect of moxonidine, an alpha-2-adrenergic agonist, on histamine-induced bronchial constriction and ventilatory occlusion responses to carbon dioxide in asthmatics. 3rd Cardiovascular Pharmacology International Symposium, 1989, KyotoGoogle Scholar
  12. 12.
    Jaeger B, Verboom C, Brunner H. The clinical efficacy of moxonidine in hypertension. Rev Contemp Pharmacother 1998; 9: 463–71Google Scholar
  13. 13.
    Frei M, Kuster L, Gardosch von Krosigk PP, et al. Moxonidine and hydrochlorothiazide in combination: a synergistic antihypertensive effect. J Cardiovasc Pharmacol 1994; 24Suppl. 1: 25–8CrossRefGoogle Scholar
  14. 14.
    Kraft K, Vetter H. Twenty-four-hour blood pressure profiles in patients with mild-to-moderate hypertension: moxonidine versus captopril. J Cardiovasc Pharmacol 1994; 24Suppl. 1: 29–33CrossRefGoogle Scholar
  15. 15.
    Ollivier JP, Christen MO. I1-imidazoline-receptor agonists in the treatment of hypertension: an appraisal of clinical experience. J Cardiovasc Pharmacol 1994; 24Suppl. 1: 39–48CrossRefGoogle Scholar
  16. 16.
    Prichard BNC, Simmons R, Rooks MJ, et al. A double-blind comparison of moxonidine and atenolol in the management of patients with mild to moderate hypertension. J Cardiovasc Pharmacol 1992; 20Suppl. 4: 45–9CrossRefGoogle Scholar
  17. 17.
    Wolf R. The treatment of hypertensive patients with a calcium antagonist or moxonidine: a comparison. J Cardiovasc Pharmacol 1992; 20Suppl. 4: 42–4CrossRefGoogle Scholar
  18. 18.
    Schachter M, Luszick J, Jaeger B, et al. Safety and tolerability of moxonidine in the treatment of hypertension. Drug Saf 1998; 19: 191–203PubMedCrossRefGoogle Scholar
  19. 19.
    Sides GD, Leschinger MI, Walenta R, et al. The tolerability and adverse event profile of moxonidine. Rev Contemp Pharmacother 1998; 9: 491–98Google Scholar
  20. 20.
    Feuring M, Cassel W, Stawenow D, et al. Safety of moxonidine in patients with mild-to-moderate hypertension and chronic pulmonary disease [abstract]. Eur J Clin Pharmacol 1996; 50: 533Google Scholar

Copyright information

© Adis International Limited 2000

Authors and Affiliations

  • Martin Feuring
    • 1
  • Werner Cassel
    • 2
  • Barbara Thun
    • 3
  • Ludger Grote
    • 2
  • Martin Wehling
    • 1
  • Thomas Penzel
    • 2
  • Joerg Hermann Peter
    • 2
  1. 1.Institute of Clinical Pharmacology, Faculty of Clinical Medicine MannheimUniversity of HeidelbergMannheimGermany
  2. 2.Clinic of Internal Medicine of the Philipps UniversityMarburgGermany
  3. 3.P.F.K. GmbHInstitute of Medical ResearchKaufbeurenGermany

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