From the Guidelines
Lisinopril and hydralazine can be used together as part of a comprehensive blood pressure management plan, particularly for patients with resistant hypertension or heart failure. The combination of these medications works through different mechanisms to lower blood pressure, providing complementary effects. Lisinopril, an ACE inhibitor, blocks the conversion of angiotensin I to angiotensin II, reducing blood vessel constriction, while hydralazine directly relaxes arterial smooth muscle. According to the American Heart Association's 2018 scientific statement on resistant hypertension 1, hydralazine can be added to the treatment regimen for patients with resistant hypertension, with a recommended dose of 25 mg three times daily, titrated upward to the maximum dose as needed. When using lisinopril and hydralazine together, patients should be monitored for potential side effects, including dizziness, headache, or excessive blood pressure lowering, especially when starting therapy or adjusting doses. Regular blood pressure monitoring is essential, and patients should stay well-hydrated and avoid standing up quickly to minimize dizziness. Kidney function should be monitored periodically, as lisinopril can affect renal function, particularly in those with pre-existing kidney disease. The 2013 ACCF/AHA guideline for the management of heart failure also supports the use of hydralazine in combination with other medications for the treatment of heart failure with reduced ejection fraction 1. Overall, the combination of lisinopril and hydralazine can be a useful treatment strategy for patients with resistant hypertension or heart failure, but requires careful monitoring and individualized dosing. Key considerations include:
- Monitoring for potential side effects, such as dizziness and headache
- Regular blood pressure monitoring
- Periodic monitoring of kidney function
- Individualized dosing based on blood pressure response and tolerance.
From the Research
Interaction between Lisinopril and Hydralazine
- There is no direct evidence in the provided studies that specifically addresses the interaction between Lisinopril and Hydralazine 2, 3, 4, 5.
- However, it is known that both Lisinopril and Hydralazine are used to treat hypertension, and their combined use may lead to enhanced blood pressure reduction 2, 3.
- A study on the hemodynamic response to vasodilation due to calcium channel antagonism with nifedipine and direct-acting agonism with hydralazine in chronic refractory congestive heart failure found that hydralazine resulted in a greater increase in stroke volume index, cardiac index, and stroke work index compared to nifedipine 5.
- Another study reported a case of profound hypotension following concomitant administration of tizanidine and lisinopril, highlighting the potential risk of hypotension when combining lisinopril with other medications 6.
- It is essential to exercise caution when administering lisinopril with other medications, including hydralazine, due to the potential risk of adverse interactions 2, 6.
Side Effects and Considerations
- Hydralazine has been associated with various side effects, including autoimmune diseases such as hydralazine-induced antineutrophil cytoplasmic antibody-associated vasculitis (ANCA-vasculitis) and lupus-like syndrome 4.
- Lisinopril is generally well-tolerated, but caution should be used when administering it with diuretics, nifedipine, or agents that may increase concentrations of potassium 2.