Step-down of enalapril treatment for arterial hypertension

Enalapril treatment (20 mg every 12 hours) of 24 patients with essential hy pertension and left ventricular (LV) hypertrophy established normal blood p ressures after 8 weeks, and after 5 years, it had reduced LV mass index by 39% (from 148+/-34 to 90+/-16 g/m(2)) and had normalized LV structure and f unction and QT dispersion. Stepwise reduction of the enalapril dosage from 40 to 30, 20, 10, and 5 mg/d during the eighth year caused no significant c hange in blood pressure, LV structure, LV systolic function, or QT dispersi on, which all likewise remained unaltered during an additional 2-year perio d of the 5-mg/d regimen. We conclude that for hypertensive patients in whom prolonged treatment with high doses of enalapril has normalized blood pres sure, LV structure, LV function, and QT dispersion, the dose may be reduced as much as 8-fold without detriment to cardiovascular control. The use of smaller doses is evidently advantageous from the point of view of health co sts.