Reactions 480 - 4 Dec 1993

Quinapril

First dose hypotension: incidence studyA study of 2242 patients with mild to moderate essential

hypertension (diastolic BP ≥ 95mm Hg and ≤ 120mm Hg)found that the incidence of first dose hypotension withquinapril was similar to that with placebo and was not dose-dependent. Patients, aged 21–75 (mean 57) years, wererandomly allocated to receive a single dose of either placebo,or quinapril 5mg or 10mg in a double-blind fashion. First dosehypotension (sitting or any standing systolic BP < 100mm Hgor a reduction in systolic BP ≥ 20mm Hg between the lastsitting and 30 sec standing measurements) occurred in 3.7%(n = 27) of patients on placebo, in 4.6% (34) of patients onquinapril 5mg and in 4.2% (31) of patients on quinapril 10mg.Symptoms suggestive of hypotension, mainly dizziness, werereported by 5.0%, 5.7% and 6.6% of patients in the placebo,quinapril 5mg and 10mg groups, respectively. The incidenceof symptomatic first dose hypotension was very low: 0.1%,0.4% and 0.3% on placebo, quinapril 5mg and 10mg,respectively. There were significant reductions in sitting BPafter 2h in all three groups (p < 0.0001 vs baseline). However,mean BP reductions were greater in the quinapril groups vsplacebo group (p < 0.0001).

Author comment: ‘The fact that no serious events wereidentified in the 1488 patients treated with quinapril suggeststhat the incidence is no greater than about 1 in 500 patients.’Maclean D, et al. The incidence of first-dose hypotension with quinapril in patientswith mild to moderate hypertension. British Journal of Clinical Practice 47:234-236, Sep-Oct 1993 - Scotland 800224756

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Reactions 4 Dec 1993 No. 4800114-9954/10/0480-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved