Accupril®( Quinapril ) 의 항고혈압 효과 및 내약성에 관한 연구

Abstract

In order to investigate the antihypertensive effect and tolerance(especially with regard to angiotensin- converting enzyme(ACE) inhibitor-induced cough of oral Accupril(quinapril hydrochloride), a new class of non-sulfhydryl-containing ACE inhibitor, we per formed 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 was administered for 4 weeks. At the end of 4 weeks, the dose of Accupril 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 not reach 90 mmHg or less, or mean arterial blood pressure decreased less than 13 mmHg. 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 peritoneal 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±10.4mrnHg). 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 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 was effective and well tolerated in pa- tients with hypertension including ESRF maintaining with CAPD but cough was the rnain side effect to be solved.