[Hypotension followed the first dose of angiotensin-converting enzyme inhibitor in patients with heart failure (a multicenter clinical trial)].

AIM: To study the hypotensive effect of the first dose in administration of perindopril and enalapril in patients with chronic cardiac failure (CCF).

MATERIAL AND METHODS: The trial enrolled 213 patients with CCF of functional class II-III (mean age 57 +/- 1.4 years, 155 males and 58 females). The patients were randomized into 2 groups. Group 1 received perindopril in a dose 2 mg, group 2 received enalapril. Arterial pressure was measured for 10 hours with a 30-min interval, in the last 3 hours--once an hour. First dose hypotension was stated if systolic pressure was < 90 mmHg, diastolic under 60 mmHg, mean pressure < 75 mmHg after the first intake of the drug.

RESULTS: Significant differences in the baseline pressure between the groups were absent. None of the patients demanded therapy of arterial hypotension. Side effects of hypotension were absent. In group 1 systolic pressure fell under 90 mmHg in 8(7.7%) patients, in group 2--in 24(22.0%) patients (p = 0.004), diastolic pressure fell under 60 mmHg in 47(45.2%) and 60(55.1%) patients, respectively (p = 0.151). Mean arterial pressure was < 75 mmHg in 42(40.4%) and 62(56.9%) patients, respectively, (p = 0.016). Multivariate correlation analysis has revealed a direct correlation between the first dose hypotension and age (r = 0.159, p < 0.01) and age > 70 years (r = 0.258, p < 0.01), acute myocardial infarction (r = 0.244, p < 0.01) and inverse correlation with the initial arterial pressure (r = -0.208, p < 0.01).