Rational Pharmacotherapy in Cardiology

Advanced search


Full Text:


Aim. To study the changes in the stiffness of the arterial wall, vasomotor function of the endothelium, and appearance of new cases of atrial fibrillation (AF) in patients with arterial hypertension with long-term treatment with lisinopril.

Material and method. 66 hypertensive patients with cardiac sinus rhythm at the age of 48-64 years (mean age 58.4±4.2 years) were included into the study. They were randomized into 2 groups: patients of group 1 (n=35) were prescribed lisinopril or a combination of lisinopril with hydrochlorothiazide over the 5-year follow-up; patients of group 2 (control) did not receive angiotensin converting enzyme inhibitors or angiotensin II receptor blockers. The follow-up duration was from September 2010 until June 2016. It included telephone calls once every 3 months and annual clinical, instrumental and laboratory examination. The new-onset AF was identified by the 24-hour Holter ECG monitoring results and by patient symptom diaries.

Results. New-onset AF was registered in 2 patients (6%) in the lisinopril group and in 4 patients (13%) from the control group (p=0.001) over the 5-year follow-up. Lisinopril significantly reduced AF incidence in hypertensive patients. The patients on lisinopril were found to have no significant changes in the left ventricular mass index and left atrial size according to echocardiography done after the 5-year follow-up whereas in the patients of control group both parameters increased significantly. Lisinopril contributed to the maintenance of endothelial vasodilator function and prevented increase in arterial wall stiffness.

Conclusion. Long term lisinopril treatment was found to significantly reduce the AF incidence in hypertensive patients over the 5-year follow-up. Lisinopril demonstrated organoprotective properties throughout the cardiovascular disease continuum and can be recommended for primary prevention of arrhythmia in hypertensive patients. 

About the Authors

V. I. Podzolkov
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

MD, PhD, Professor, Head of Chair of Faculty Therapy №2,

Trubetskaya ul. 8-2, Moscow, 119991

A. I. Tarzimanova
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

MD, PhD, Associate Professor, Chair of Faculty Therapy №2, 

Trubetskaya ul. 8-2, Moscow, 119991

R. G. Gataulin
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

MD, Resident, Chair of Faculty Therapy №2,

Trubetskaya ul. 8-2, Moscow, 119991


1. Lip G.Y., Tse H.F., Lane D.A. Atrial fibrillation. Lancet. 2012;379:648-61. doi: 10.1016/S0140- 6736(11)61514-6.

2. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37(38):2893-962. doi: 10.1093/eurheartj/ehw210.

3. Oudot A., Vergely C., Ecarnot-Laubriet A., et al. Angiotensin II activates NADPH oxidase in isolated rat hearts subjected to ischaemia-reperfusion. Eur J Pharmacol. 2003;462:145-54. doi: 10.1016/S0014-2999(03)01315-3.

4. Kaibara M., Mitarai S., Yano K., et al. Involvement of Na+-H+ antiporter in regulation of L-type Ca2+ channel current by angiotensin II in rabbit ventricular myocytes. Circ Res. 1994;75:1121-5. doi: 10.1161/01.RES.75.6.1121.

5. Benitah J.P., Vassort G. Aldosterone upregulates Ca2+ current in adult rat cardiomyocytes. Circ Res. 1999;85:1139-45. doi: 10.1161/01.RES.85.12.1139.

6. Shang L.L., Sanyal S., Pfahnl A.E., et al. NF-κB-dependent transcriptional regulation of the cardiac scn5a sodium channel by angiotensin II. Am J Physiol Cell Physiol. 2008;294:C372-92007. doi: 10.1152/ajpcell.00186.2007.

7. Kasi V.S., Xiao H.D., Shang L.L., et al. Cardiac-restricted angiotensin-converting enzyme overexpression causes conduction defects and connexin dysregulation. Am J Physiol Heart Circ Physiol. 2007;293:H182-H192. doi: 10.1152/ajpheart.00684.2006.

8. Wachtell K., Lehto M., Gerdts E., et al. Angiotensin II receptorblockade reduces new-onset atrial fibrillation and subsequent strokecompared to atenolol: the Losartan Intervention for End PointReduction in Hypertension (LIFE) study. J Am Coll Cardiol. 2005;45:712-19. doi: 10.1016/j.jacc.2004.10.068.

9. Schmieder R.E., Kjeldsen S.E., Julius S., et al. Reduced incidence of new-onset atrial fibrillation withangiotensin II receptor blockade: the VALUE trial. J Hypertens. 2008;26:403-11. doi: 10.1097/HJH.0b013e3282f35c67.

10. Hansson L., Lindholm L.H., Niskanen L., et al. Effect of angiotensinconverting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP) randomised trial. Lancet. 1999;353:611-6. doi: 10.1016/S0140-6736(98)05012-0.

11. Hansson L., Lindholm L.H., Ekbom T., et al. Randomised trial of old and new antihypertensive drugs in elderly patients: cardiovascular mortality and morbidity the Swedish Trial in Old Patients WithHypertension-2 study. Lancet. 1999;354:1751-6. doi: 10.1016/S0140-6736(99)10327-1.

12. Salehian O., Healey J., Stambler B., et al. Impact of ramipril on the incidence of atrial fibrillation: results of the Heart Outcomes Prevention Evaluation study. Am Heart J. 2007;154:448-53. doi: 10.1016/j.ahj.2007.04.062.

13. Yusuf S., Teo K., Anderson C., et al. Effects of the angiotensin-receptor blocker telmisartan on cardiovascular events in high-risk patients intolerant to angiotensin-converting enzyme inhibitors: a randomized controlled trial. Lancet. 2008;372:1174-83. doi: 10.1016/S0140-6736(08)61242-8.

14. Mancia G., Zanchetti A. et al. Study on monitoring of blood pressure and lisinopril evaluation. Circulation. 1997; 95(6);1464-70. doi: 10.1161/01.CIR.95.6.1464.

15. Terpstra W.F., May J.F., Smit A.J. et al. Long-term effects of amlodipine and lisinopril on left ventricular mass and diastolic function in elderly, previously untreated hypertensive patients: the ELVERA trial. J Hypertens. 2001;19(2):303-9.


For citations:

Podzolkov V.I., Tarzimanova A.I., Gataulin R.G. CARDIOPROTECTIVE PROPERTIES OF LISINOPRIL: NEW POSSIBILITIES. Rational Pharmacotherapy in Cardiology. 2018;14(3):319-323. (In Russ.)

Views: 1861

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)