In order to investigate the antihypertensive effect and tolerance(especiallv with regard to angiotensinconverting enzyme(ACE) inhibitor-induced cough) oforal Accupril(r)(quinaprii hydrochloride), a new class of non-sulfhydryl-containing ACE
inhibitor,
we performed a clinical study in the 36 patients with essential and renal hypertension. Following 2 weeks of wash-out and placebo phase, a single daily dose of 10mg of Accupril(r) was administered for 4 weeks At the end of Accupril(r) was
increased
to
20 mg for another 4 weeks if SBP (systolic blood pressure)/DBP(diastolic blood pressure) decreased less than 20/10mmHg from baseline, if DBP did reach 90 mmHg or less, or mean arterial blood pressure decreased less than 13 mnilg Blood pressure
and
heart
rate were measured at baseline, 1, 2, 4, 6, and 8 weeks after administration in sitting position. The laboratory tests were performed at the baseline and at the end of 8th week.
Of the 36 patients, 41.7% was male. The mean age was 47.5±10.5 years, mean duration of hypertension 67.3±61.1 months, and mean stage of hypertension was 3.0±0.8 The primary diseases were essential hypertension in 15, chronic renal failure in
14,
end
stage renal failure(ESRF) with continuous ambulatory peritoncal dialysis(CAPD) in 4, autosomal dominant polycystic kidney disease in 2, and focal segmental glomerulosclerosis in 1. There was a statistically significant reduction of SBP/DBP after
4
weeks
of treatment compared to the baseline(152.2±26.2/93.7±10.8 vs. 182.1±20.4/107.1±10.2 mmHg, p<0.05), which was maintained up to 8 weeks(147.1±22.9/90.7±10.4mmHg). The overall an tihypertensive efficacy was 85.2%. There were no significant
changes
in the pulse rate and laboratory results before and 8 weeks after treatment. During the follow-up period, 15 cases(follow-up loss 4, uncontrolled BP 3, severe ACE inhibitor-induced cough 6, hyperkalemia 1, and severe headache with dizziness
1)were
dropped-out. ACE inhibitor-induced cough was observed in 11 cases(30.6%), of whom severe cough requiring the withdrawal-of Accupril(r) occurred in 6 cases(16.7%). Other side effects were headache and dizziness(1 case) and hyperkalemia(1 case).
In conclusion, antihypertensive therapy with Accupril(r) was effective and well tolerated in patients with hpertension including ESRF maintaining with CAPD but cough was the main side effect to be solved.
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