ASSESSING THE CLINICAL NEED FOR SHORT-TERM CONVERSION FROM ORAL TO PARENTERAL ANGIOTENSIN-CONVERTING ENZYME-INHIBITOR THERAPY IN HYPERTENSIVE PATIENTS - A QUINAPRIL TO QUINAPRILAT PLACEBO-CONTROLLED MODEL

Rationale and study design This study assesses safety and efficacy whe n hypertensive patients convert from an oral angiotensin converting en zyme inhibitor, quinapril, to its intravenous counterpart, quinaprilat , and evaluates the need for short-term conversion from oral to parent eral therapy. Blood pressure was measured by clinical measurements usi ng a sphygmomanometer and by 24-h ambulatory blood pressure monitoring . During a placebo-baseline phase, patients' blood pressure had to inc rease within 3 days in the absence of an angiotensin converting enzyme inhibitor. Responding patients were stabilized on oral quinapril and then randomized to 3 days of double-blind treatment with one 5 ml or 1 0 ml injection twice daily of quinaprilat or placebo. Results Overall response to quinaprilat in ambulatory blood pressure monitoring and cl inic blood pressure measurements was not statistically or clinically d ifferent from the response to oral quinapril therapy during baseline. Withdrawal from quinapril resulted in clinically significant increases in ail blood pressure measurements compared with baseline therapy; th e differences between placebo and quinaprilat therapy were statistical ly and clinically significant. Two patients treated with quinaprilat w ithdrew due to hypotension; one patient required a dosage reduction. P arenteral quinaprilat safely maintained blood pressure control whereas placebo control did not during the 72-h interruption of quinapril.