Summary
The antihypertensive and hormonal effects of the new angiotensin-converting enzyme (ACE) inhibitor, ramipril, were assessed by means of a single-blind trial in ten unselected patients with mild-to-moderate essential hypertension. After a 2-week period on placebo, 5 mg ramipril was administered once daily for 2 weeks. Blood pressure returned to normal in five patients and decreased in the remaining patients, without significant changes in heart rate or orthostatic hypotension. A fall in blood pressure was apparent within 1–2 h of the first dose; the maximum decrease was reached at 4–6 h and a fall in pressure was still detectable after 24 h. At 24 h post dose angiotensin-converting enzyme activity was suppressed to 40% of the baseline. Blood pressures for the 10 h interval post dosing showed smooth through-the-day control with minimal peak/trough difference in lowering effect. The magnitude of the blood pressure decrement achieved with the inhibitor did not correlate with baseline renin levels or the rise in renin following treatment. No side-effects were noted during the 2-week observation period. The study demonstrates that ramipril, given in a once-daily regimen over a period of 2 weeks, is well tolerated and provides smooth and effective blood pressure control throughout the 24-h interval between doses.
Similar content being viewed by others
Abbreviations
- ACE:
-
angiotensin converting enzyme
- PRA:
-
plasma renin activity
References
Becker RHA, Schölkens BA, Metzger H, Schulze KJ (1984) Pharmacological properties of the new orally active converting enzyme inhibitor HOE 498. Arzneimittelforsch 34(II):1411–1416
Cody RJ, Tarazi RC, Bravo EL, Fouad FM (1979) Hemodynamics of an orally-active converting enzyme inhibitor (SQ 14,225) in hypertensive patients. Clin Sci Mol Med 55:453–459
Cushman DW, Cheung HS (1971) Spectrophotometric assay and properties of the angiotensin-converting enzyme of rabbit lung. Biochem Pharmacol 20:1637–1648
Cushman DW, Cheung HS, Sabo EF, Ondetti MA (1977) Design of potent competitive inhibitors of angiotensin-converting enzyme. Carboxyalkanoyl and mercaptoalkanoyl amino acids. Biochemistry 16: 5484–5491
Davis JO, Freeman RH (1976) Mechanisms regulating renin release. Physiol Rev 56:1–56
Felder K, Witte PU (1984) Effects of the new oral angiotensin converting enzyme inhibitor HOE 498 in essential hypertension. Arzneimittelforsch 34(II):1452–1454
Gavras H, Brunner HR (1978) Angiotensin-converting enzyme inhibitor in refractory hypertension. N Engl J Med 299:363–364
Gomez HJ, Cirillo VJ, Jones KH (1983) The clinical pharmacology of enalapril. Hypertension 1:65–70
Groel JT, Tadros SS, Dreslinski GR, Jenkins AC (1983) Long-term antihypertensive therapy with captopril. Hypertension 5:III145-III151
Haber E, Koerner T, Page LB, Kliman B, Purnode A (1969) Application of a radioimmunoassay for angiotensin I to the physiologic measurement of plasma renin activity in normal human subjects. J Clin Endocrinol 29:1349–1355
Havelka J, Vetter H, Studer A, Greminger P, Lüscher T, Wollnik S, Siegenthaler W, Vetter W (1982) Acute and chronic effects of the angiotensin-converting enzyme inhibitor captopril in severe hypertension. Am J Cardiol 49:1467–1474
Laragh JH, Case DB, Atlas SA, Sealey JE (1980) Captopril compared with other antirenin system agents in hypertensive patients: its triphasic effects on blood pressure and its use to identify and treat the renin factor. Hypertension 2:586–593
Patchett AA, Harris E, Tristram EW, Wyvratt MJ, Wu MT, Taub D, Peterson ER, Ikeler TJ, tenBroeke J, Payne LG, Ondeyka DL, Thorsett ED, Greenlee WJ, Lohr NS, Hoffsommer RD, Joshua H, Ruyle WV, Rothrock JW, Aster SD, Maycock AL, Robinson FM, Hirschmann R, Sweet CS, Ulm EH, Gross DM, Vassil TC, Stone CA (1980) A new class of angiotensin-converting enzyme inhibitors. Nature 288:280–283
Schölkens BA, Becker RHA, Kaiser J (1984) Cardiovascular and antihypertensive activities of the novel non-sulfhydryl converting enzyme inhibitor HOE 498. Arzneimittelforsch 34II:1417–1425
Stumpe KO, Overlack A, Kolloch R, Schreyer S (1982) Long-term efficacy of angiotensin-converting-enzyme inhibition with captopril in mild-to-moderate essential hypertension. Br J Clin Pharmacol 14:121–126
Veterans administration cooperative study group on antihypertensive agents (1982) Captopril: evaluation of low doses, twice-daily doses and the addition of diuretic for the treatment of mild to moderate hypertension. Clin Sci 63:443s-445s
Veterans administration cooperative study group on antihypertensive agents (1983) Low-dose captopril for the treatment of mild to moderate hypertension. Hypertension 5:III139-III144
Witte PU, Metzger H, Irmisch R (1983) Pharmacodynamics of a new orally active long acting angiotensin converting enzyme inhibitor (HOE 498) in healthy subjects. IRCS Med Sci 11:1053
Witte PU, Metzger H, Eckert HG, Irmisch R (1984a) Tolerance and pharmacodynamics of the angiotensin converting enzyme inhibitor HOE 498 in healthy volunteers. Arzneimittelforsch 34(II):1448–1481
Witte PU, Irmisch R, Hajdú P, Metzger H (1984b) Pharmacokinetics and pharmacodynamics of a novel orally active angiotensin converting enzyme inhibitor (HOE 498) in healthy subjects. Eur J Clin Pharmacol 27:577–581
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Stumpe, K.O., Overlack, A., Kolloch, R. et al. Effects of the new angiotensin-converting enzyme inhibitor, ramipril, in patients with essential hypertension. Klin Wochenschr 64, 558–562 (1986). https://doi.org/10.1007/BF01735319
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01735319