Hypotension after Administration of the First Dose of Angiotensin-Converting Enzyme (ACE) Inhibitors in Patients with Congestive Heart Failure

*Tamara Tsibadze, **Naira Kobaladze,*** Marina Iakobashvili, ***Gulnara Tabidze 

*Department of Internal Medicine N1, Tbilisi State Medical University, Georgia;
**Central Clinical Hospital, Batumi, Georgia;
***Institute of Cardiology, Tbilisi, Georgia

First-dose hypotension refers to an observed reduction in blood pressure after the administration of the first dose of ACE inhibitors in patients with congestive heart failure. We aimed to compare the first-dose responses of low-dose enalapril and accupro in patients with stable symptomatic chronic heart failure. Methods: Single blind, randomized study. Patients (N=80) with chronic heart failure due to ischemic heart disease, NYHA II-IV, ejection fraction<40%, age>18 year were randomized to receive a single dose of 2,5 mg enalapril or 5 mg accupro. Ambulatory blood pressure monitoring started 2h before the study medication was given, and continued for at least 10h after the medication. Results: The maximum drop in blood pressure appeared approximately 4h after dose administration in both groups, and was more pronounced in the enalapril group. Patients in the enalapril group had a significantly higher incidence of asymptomatic hypotension. No symptomatic hypotension requiring a change in medication or a prolongation of hospitalization was observed. Conclusion: A low dose of accupro is well tolerated at initiation of ACE inhibitor therapy in patients with chronic heart failure and causes less first-dose hypotension than a low dose of enapril.

Keywords:  first-dose hypotension, congestive heart failure, enalapril, accupro