Efficacy of fosinopril in the control of 24-hour blood pressure in hemodialysis patients using ambulatory blood pressure monitoring

Twenty-four-hour ambulatory blood pressure monitoring (ABPM) was used to as sess the efficacy and tolerability of fosinopril, an angiotensin-converting enzyme inhibitor, in 20 hemodialysis patients (12 men, 8 women; aged 28 to 64 years [mean, 54 +/- 9 years]) with mild-to-moderate hypertension. After a 4-week washout period, during which the lowest possible dry weight was a chieved, patients were given fosinopril 10 mg/d orally if their predialysis blood pressure (BP) was greater than or equal to 140/90 mm Hg. If BP was n ot controlled, the dosage was increased every 2 weeks as needed to a maximu m of 40 mg/d. Fosinopril was administered for a total duration of 12 weeks. ABPM was done at the beginning of the study and repeated after 6 and 12 we eks of treatment. Significant changes in mean 24-hour systolic and diastoli c BP were seen from baseline to week 12 (from 150.3 +/- 4.8 to 138.2 +/- 3. 1 mm Hg and from 95.0 +/- 2.8 to 84.3 +/- 3.1 mm Hg, respectively) (P < 0.0 001). significant reductions in mean 24-hour systolic and diastolic BP betw een baseline and week 6 were noted (from 150.3 < 4.8 to 136.1 +/- 4.8 mm Hg and from 95.0 +/- 2.8 to 82.6 +/- 2.5 mm Hg, respectively). The smoothness of BP control was demonstrated by a trough:peak ratio of 58% for ambulator y systolic BP and 62% for diastolic BP. In addition, at 12 weeks, fosinopri l induced a significant reduction in systolic BP load from 66.6 +/- 20.0% t o 39.2 +/- 16.5% and diastolic BP load from 67.1 +/- 22.8% to 31.4 +/- 6.6% (P < 0.001). Blunting of the circadian rhythm was noted in all patients at study entry. No significant adverse effects were observed. Findings from t he present study suggest that fosinopril, given in the usual doses, is well tolerated and results in smooth BP control in hemodialysis patients with m ild-to-moderate hypertension.