comparative effects of cilazarpil, atenolol, and nifedipine on maximal exercise performance

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A Comparative Evaluation of Cilazapril and Lisinopril in the Treatment of Mild to Moderate Essential Hypertension Using Ambulatory Blood Pressure J. Po-Shan, C.P. Lau, Y.T. Tai, P.C. Fong Tung Wah Hospital Sheung Wan, Hong Kong A randomized, double-blind, crossoverstudy compared the antihypertensive effects of two angiotensin- converting enzyme inhibitors, cilazapril and lisinopril, in 30 patients with mild to moderate essential hypertension (sitting diastolic blood pressures:95 to 115 mm Hg). After a 2-week baseline washout period (placebo), patients were given either cilazapril or lisinopril, and the doseswere titrated to achieve a sitting diastolic blood pressure lessthan or equal to 90 mm Hg. After 8 weeks of therapy with either drug, the patients received the alternative treatment, again after a placebo period of 2 weeks. Blood pressure assessments were made using both office and ambulatory blood pressure monitoring. During the first placebo phase and at the end of each active treatment period, an ambulatory blood pressure recording was carried out for 24 hours. The mean dosesof cilazapril and lisinopril were 3 mg and 11 mg, respectively. The office systolic, diastolic, and mean blood pressures after treatment with both cilazapril and lisinopril showed a significant reduction in all the parameters compared with placebo, but no difference was found between the two medications. The area under the curve analysis of ambulatory blood pressure reductions showed lower hyperbaric indices during cilazapril treatment, with a significant reduction in the index for diastolic blood pressure (p <0.05). There was no change in laboratory profiles, and five patients discontinued treatment because of cough. We concluded that both drugs were tolerated and could safely be administered as first-line therapy. Cilazapril and lisinopril were both effective in lowering blood pressure in patients with essential hypertension. At dosagesthat achieved similar blood pressure at clinical visits, cilazapril caused a more sustained control of blood pressure over 24 hours than lisinopril. Comparative Effects of Cilazapril, Atenolol, and Nifedipine on Maximal Exercise Performance E.W. Derman, R. Sims, T. D. Noakes University of Capetown UCT Medical School Cape Town, South Africa In a previous study, we showed that clinically prescribed doses of cilazapril (C), nifedipine (N), and atenolol (A) impaired performance during exerciseof progressively increasing intensity to exhaustion. To determine whether that effect was due to altered skeletal muscle contractile function, we measured skeletal muscle function during short-duration, high-intensity exercise in the same population. In a double-blind, crossovertrial, 10 healthy male volunteers performed (1) maximal isokinetic cycling for determination of peak (PP) and average (AP) power, and (2), as previously described, progressive aerobic exercise to exhaustion for determination of maximal oxygen consumption (VOzmax), after single- dose ingestion of C, N, A, and placebo (PL). Neither PP nor AP was altered by any agent. Exercise time to exhaustion during progressive exercisewas decreased by all agents (p <0.05 versusPL), but VOzmax was decreased by A only (p <0.05 versus PL). The finding that C, N, and A all impaired exercise performance without altering resting skeletal muscle contractile function suggestseither that altered skeletal muscle contractile function does not explain the detrimental effect of these agents on exercise performance, or that these agents produce effects on skeletal muscle that are not identifiable by these testing procedures. September 1993 The American Journal of Medicine Volume 95 345

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Page 1: Comparative effects of cilazarpil, atenolol, and nifedipine on maximal exercise performance

A Comparative Evaluation of Cilazapril and Lisinopril in the Treatment of Mild to Moderate Essential Hypertension Using Ambulatory Blood Pressure

J. Po-Shan, C.P. Lau, Y.T. Tai, P.C. Fong Tung Wah Hospital Sheung Wan, Hong Kong

A randomized, double-blind, crossover study compared the antihypertensive effects of two angiotensin- converting enzyme inhibitors, cilazapril and lisinopril, in 30 patients with mild to moderate essential hypertension (sitting diastolic blood pressures: 95 to 115 mm Hg). After a 2-week baseline washout period (placebo), patients were given either cilazapril or lisinopril, and the doses were titrated to achieve a sitting diastolic blood pressure less than or equal to 90 mm Hg. After 8 weeks of therapy with either drug, the patients received the alternative treatment, again after a placebo period of 2 weeks. Blood pressure assessments were made using both office and ambulatory blood pressure monitoring. During the first placebo phase and at the end of each active treatment period, an ambulatory blood pressure recording was carried out for 24 hours. The mean doses of cilazapril and lisinopril were 3 mg and 11 mg, respectively.

The office systolic, diastolic, and mean blood pressures after treatment with both cilazapril and lisinopril showed a significant reduction in all the parameters compared with placebo, but no difference was found between the two medications. The area under the curve analysis of ambulatory blood pressure reductions showed lower hyperbaric indices during cilazapril treatment, with a significant reduction in the index for diastolic blood pressure (p <0.05). There was no change in laboratory profiles, and five patients discontinued treatment because of cough.

We concluded that both drugs were tolerated and could safely be administered as first-line therapy. Cilazapril and lisinopril were both effective in lowering blood pressure in patients with essential hypertension. At dosages that achieved similar blood pressure at clinical visits, cilazapril caused a more sustained control of blood pressure over 24 hours than lisinopril.

Comparative Effects of Cilazapril, Atenolol, and Nifedipine on Maximal Exercise Performance

E.W. Derman, R. Sims, T. D. Noakes University of Capetown UCT Medical School Cape Town, South Africa

In a previous study, we showed that clinically prescribed doses of cilazapril (C), nifedipine (N), and atenolol (A) impaired performance during exercise of progressively increasing intensity to exhaustion. To determine whether that effect was due to altered skeletal muscle contractile function, we measured skeletal muscle function during short-duration, high-intensity exercise in the same population. In a double-blind, crossover trial, 10 healthy male volunteers performed (1) maximal isokinetic cycling for determination of peak (PP) and average (AP) power, and (2), as previously described, progressive aerobic exercise to exhaustion for determination of maximal oxygen consumption (VOzmax), after single- dose ingestion of C, N, A, and placebo (PL). Neither PP nor AP was altered by any agent. Exercise time to exhaustion during progressive exercise was decreased by all agents (p <0.05 versus PL), but VOzmax was decreased by A only (p <0.05 versus PL).

The finding that C, N, and A all impaired exercise performance without altering resting skeletal muscle contractile function suggests either that altered skeletal muscle contractile function does not explain the detrimental effect of these agents on exercise performance, or that these agents produce effects on skeletal muscle that are not identifiable by these testing procedures.

September 1993 The American Journal of Medicine Volume 95 345