Comparative study of the antihypertensive effects of enalapril (enama) and captopril (capoten) in patients with arterial hypertension

In terms of frequency of occurrence, hypertension is considered the most common pathology of the cardiovascular system. In most cases, the development of the disease is caused by an incorrect lifestyle, heredity and excessive production of biologically inactive angiotensin. Therapy for arterial hypertension is based on taking synthetic drugs that slow down the production of the hormone angiotensin, which leads to a decrease in blood pressure. As a rule, to normalize blood pressure, specialists prescribe Captopril or Capoten. These drugs are similar in their effect, but have different prices. So, patients have a question, which is better – Capoten or Captopril?

Why is there a question of choosing tablets?

There are dozens of antihypertensive drugs on the pharmaceutical market based on the same active substance. According to official instructions, the drugs have a similar effect, composition, and dosage. At the same time, attending physicians prescribe different pills to patients with the same diagnoses.

The choice of therapy is influenced by factors such as the severity of the underlying disease, a history of concomitant chronic pathologies of internal organs, and age. Changing the prescribed drug on your own creates a high risk of side effects.

Adaptation of the body to the new components of the tablets can take from 5-7 days to several weeks, months and is accompanied by a persistent increase in blood pressure.

If there is a need to change medications, this process is carried out under the supervision of a doctor with regular blood pressure measurements (3-5 times a day). The patient must also do blood tests - general clinical and biochemical to determine the electrolytes of calcium, potassium, chloride, sodium.

Reviews

Nadezhda Viktorovna, 57 years old Since I have been suffering from high blood pressure for 10 years, both drugs periodically appear in my home medicine cabinet. Very often, even after minor nervous stress, my blood pressure rises, my head starts to hurt and I feel nauseous. I immediately take one Capoten tablet under my tongue. The decrease in blood pressure begins within 15-20 minutes (depending on the initial indicators). The last time I had a hypertensive crisis, and I went to the hospital, where I was told that this drug must be taken systematically, and not just for high blood pressure. Now I take Capoten for 3 months, then change it to Captopril.

Veronica, 45 years old As a rule, I suffer from low blood pressure, but one day at work after another meeting I became very worried, which caused an increase in blood pressure. The employee gave me a Captopril tablet to take, which helped normalize my blood pressure in a short time. So I consider the drug effective and reliable.

Nikolay, 49 years old I am a hypertensive patient with little experience, and my blood pressure often rises to high levels. I always take Capoten as a first aid remedy. As a rule, the starting dose starts with ¼ tablet. After 20 minutes I measure the pressure. If there is no effect, I take another ¼ dose. Thus, I normalize the pressure gradually, since a critical decrease in blood pressure negatively affects the heart and blood vessels.

Chemical composition of Capoten and Captopril

Captopril is an active substance of synthetic origin, on the basis of which antihypertensive drugs are made. It is a white powder in the form of microcrystals with a faint sulfur odor.

Capoten and Captopril are the same medicine from the group of ACE inhibitors, chemical compounds for lowering blood pressure, treatment and prevention of chronic heart and kidney failure. Affects an extracellular enzyme that regulates blood pressure.

Captopril tablets are the cheapest option available to all social classes. Preferential categories of patients receive the drug in social pharmacies free of charge according to a prescription prescribed by a physician.

Kapoten is a trademark (commercial name). Produced on the basis of captopril. − chemical and pharmaceutical plant in Staraya Kupavna, Moscow region, Russia. Auxiliary components in the composition of the drugs:

• cellulose - stabilizer;
• lactose - filler;

• stearic acid - forms the structure;
• starch is a filler for tablet forms.

Different manufacturers may use other additional substances - povidone (a detoxifier, complexing agent), colloidal silicon dioxide (promotes rapid absorption), calcium stearate (ensures tablets are smooth and easy to swallow).

In what cases is it necessary to stop taking medications?

Capoten is considered a safer drug for the body, however, it also has side effects and contraindications similar to Captopril.

Captopril-based medications are not recommended for use in the following cases:

• Individual sensitivity to certain components of the drugs.
• Disturbances in the functioning of the excretory system.
• Functional disorders of the liver.
• Immunodeficiency and decreased supporting forces of the body.
• Conditions accompanied by a significant decrease in blood pressure.
• The period of bearing a child and breastfeeding.
• Age category under 16 years old.

The drugs have a pronounced hypotensive effect, so their use must be agreed with the attending physician.

If an excessive dose of medication is taken, the patient may develop collapse, shock and coma, which require emergency care.

Thus, the mechanism of action and indications for use are similar for both medications, so it is impossible to say which one is better. The choice of antihypertensive drug rests with the specialist. He will help you choose the optimal medicine, taking into account the individual characteristics of the body. Still, long-term therapy for hypertension requires alternating medications.

How do the drugs work?

Capoten and Captopril belong to the same pharmacological group - ACE inhibitor. Medicinal properties:

• hypotensive - lowers blood pressure;
• cardioprotective - prevents myocardial hypertrophy, significantly reduces the risk of developing cardiovascular complications, improves the prognosis of the disease;
• vasodilating - dilates blood vessels, increasing their lumen, reduces the tone of the walls;
• natriuretic - reduces the load on the myocardium, improves coronary blood supply.

The main substance enhances the activity of a group of specific plasma proteins that regulate the blood coagulation system (prevent clotting) and blood pressure. Under the influence of captopril, biologically active substances are released that dilate blood vessels, preventing increased stress on the heart muscle.

The hypotensive property begins to act after 15-60 minutes. after ingestion. The maximum activity of the substance is observed after 1-1.5 hours and lasts up to 6-12 hours.

In patients with hypertension, Capoten and Captopril reduce afterload with cardiac function and peripheral vascular resistance. In patients with heart failure, resistance to physical activity increases, general condition improves, life expectancy increases, night sleep and emotional status are normalized. By increasing the diameter of large arteries, it prevents the progression of renal failure, diabetic nephropathy, and the development of cardiovascular complications.

Results and discussion

The effectiveness of combinations of antihypertensive drugs is presented in table. 2.

Table 2. Efficacy of antihypertensive drugs

As can be seen from table. 2, combinations of moxonidine with nifedipine, moxonidine with furosemide, and captopril with furosemide were very highly effective. In contrast, the addition of nifedipine to captopril resulted in a sharp decrease in antihypertensive activity.

The absence of increased antihypertensive activity when adding amlodipine to captopril is also indicated by P. Kotruchin et al. [12].

Changes in blood pressure 30 minutes after taking the studied combinations of antihypertensive drugs are presented in the figure.

Decrease in systolic (a) and diastolic blood pressure (b) after taking antihypertensive drugs. 1 — moxonidine with nifedipine; 2 — moxonidine with furosemide; 3 — captopril with nifedipine; 4 — captopril with furosemide.

Combinations of moxonidine with nifedipine, moxonidine with furosemide and captopril with furosemide have pronounced antihypertensive activity (see figure). SBP is more significantly reduced by the combination of moxonidine with furosemide, and DBP by the combination of moxonidine or captopril with furosemide.

The combination of captopril with nifedipine for emergency antihypertensive therapy is ineffective.

In table 3 presented

Table 3. Adverse events of antihypertensive drugs - undesirable effects of the studied combinations of antihypertensive drugs.

As can be seen from table. 3, the least number of adverse events occurred when using a combination of moxonidine with furosemide, the maximum number of side effects was noted when captopril was prescribed with nifedipine.

As a result of the analysis of 498 emergency medical service call cards for patients with elevated blood pressure, it was found that initially during the year they called for emergency medical services 1724 times, i.e., there were 3.5 calls per patient per year. After receiving recommendations for self-help, more than half (279 out of 498) of patients with increased blood pressure did not call for emergency medical services within a year. The remaining 219 patients visited the emergency room for this issue 656 times during the year, i.e., the number of calls per patient decreased from 3.5 to 3.0 per year.

On average, the introduction of individual recommendations for self-help reduced the use of emergency medical services in connection with an increase in blood pressure from 1724 to 656 per year, i.e. by 2.6 times, without requiring additional funding.

The high incidence of arterial hypertension, the low effectiveness of its treatment, the round-the-clock availability of emergency medical services, together with the dependent attitude of patients towards their disease, are realized by the very high demand for emergency medical services at the slightest increase in blood pressure.

The increasing number of calls depletes the resources of the ambulance service and healthcare in general, not improving the course and outcome of the disease, but contributing to the transformation of a medical problem into a social problem.

Solving this problem is impossible without the cooperation of the doctor and the patient with arterial hypertension, in particular without the active use of self-help. Combinations of drugs for self-help should be selected during emergency medical care, so that both the doctor and the patient can be convinced of the effectiveness and good tolerability of the drugs.

When using self-help, you should adhere to the rules, the main ones of which are presented below.

Basic rules of self-help

1. Self-help is indicated for a typical deterioration of the patient’s condition, in particular for a typical increase in blood pressure.

2. The doctor must make sure that the patient correctly understands the content of self-help and is able to correctly follow the specified recommendations.

3. If, after taking the recommended medications, your health and condition do not improve or worsen, it is necessary, without wasting time, to call an ambulance.

4. Self-help should not replace planned therapy.

5. Self-help should not be prescribed to patients who are unable to adequately assess and control their condition.

Capoten or Captopril: purposes and contraindications

What is the difference in the action of the drugs and how Capoten differs from Captopril when prescribed depends on several factors. In essence, this is the same tool, there are no fundamental differences.

If a person has mild or moderate hypertension, systemic Captopril is prescribed. If chronic heart failure develops due to hypertension, it is better to take Capoten. Its improved chemical formula does not cause significant side effects; the tablets are well tolerated by patients of all ages. General indications:

• hypertonic disease;

• emergency care for hypertensive crisis;
• chronic heart failure - as part of complex treatment together with diuretics (diuretics), digitalis preparations (digitalis), β-blockers;
• the first day after acute myocardial infarction, provided the general condition is stable (treatment lasts no more than 4 weeks);
• long-term prevention of heart failure at the initial stage of left ventricular dysfunction, when there are no clinical symptoms;
• diabetic nephropathy (kidney damage in diabetes mellitus with impaired glomerular filtration).

Captopril-based products are prescribed from the age of 18. Absolute contraindications include pregnancy and lactation, high sensitivity to individual components, a history of dangerous forms of allergies. Medicines should not be prescribed for severe functional disorders of the kidneys, liver, aortic stenosis, or kidney transplantation.

Indications for use

Before using medications, you must consult with a specialist to clarify the diagnosis and select a therapeutic course. It is important for the patient to follow the chosen treatment regimen and not interrupt it on their own.

At an appointment with a cardiologist, the dosage, frequency of use and interval between doses of one of the drugs are determined

Indications for the use of medications are basically the same. They are prescribed for the following conditions:

• Hypertonic disease. Medicines are effective at all stages of the disease. They are prescribed both in combination with other groups of antihypertensive drugs, and as independent therapy. For long-term treatment, experts recommend Capoten.
• Impaired functional ability of the left ventricle. As a rule, the pathology develops against the background of a heart attack. After stabilizing the patient’s condition, the optimal drug is selected to restore normal activity of the heart muscle. Both drugs are well suited for this purpose.
• Diabetic nephropathy. A serious complication of diabetes mellitus is damage to the blood vessels of the kidney, which is manifested by an increase in pressure in the bloodstream. To restore the functionality of paired organs and normalize blood pressure, Capoten and Captopril are prescribed.
• Heart failure. With this disease, it is necessary to take both drugs, since due to long-term therapy it is necessary to periodically replace them.

The indications for taking medications are the same; they are used to treat diseases of the same etiology. During the treatment period, it is necessary to abstain from non-steroidal anti-inflammatory drugs, as well as from the use of table salt and foods containing large amounts of potassium.

Release form and dosage

Kapoten (25 mg) - white tablets (cream shade is allowed) with a specific odor. The shape is square, convex, with rounded edges. There is a cross-shaped notch on one side.

Captopril (25 mg) - round white tablets with a flat surface, chamfered (cut corners), one or two lines.

For medications to be more effective, they are swallowed on an empty stomach, an hour before meals. You can drink a small amount of liquid at room temperature. Initially, a minimum dose is prescribed, then it is gradually increased (over several weeks), observing the body’s reaction and the general condition of the patient.

Captopril is most often prescribed to treat hypertension. The initial dosage is 12.5 mg 2 times a day at regular intervals. After 2-4 weeks, the dose is gradually increased. Patients with moderate arterial hypertension are advised to take 25 mg 2 times a day. The daily dose should not exceed 50 mg. In severe forms of hypertension, the maximum daily dose is increased to 150 mg. In this case, treatment also begins with 12.5 mg once.

Hypertensive crisis. Emergency care methods.

Hypertensive crisis is a dangerous complication of hypertension that requires emergency care. Every person suffering from hypertension must remember that a hypertensive crisis can occur at almost any time. Therefore, not only all hypertensive patients, but also their loved ones should know how to provide first aid in case of a sharp increase in blood pressure. Hypertensive crisis is a significant, sudden increase in blood pressure with neurovascular and humoral disorders. The occurrence of hypertensive crises is facilitated by acute neuropsychic stress, excessive alcohol consumption, sudden changes in weather, withdrawal of antihypertensive drugs, etc.

There are hypertensive crisis types I and II and complicated.

Type I hypertensive crisis develops quickly, a sharp headache, dizziness, nausea, flashing before the eyes appear, and vomiting may occur. Patients are excited, feel a feeling of heat, trembling throughout the body. Red spots appear on the skin of the neck, face, and sometimes chest. The skin feels damp to the touch. Increased heart rate and a feeling of heaviness in the chest may occur. Tachycardia is noted. Blood pressure is increased, mainly systolic (up to 200 mm Hg and above). Often the crisis ends with excessive urination.

Type II hypertensive crisis often develops in patients with stage II-III hypertension due to insufficiently effective treatment or disruption of lifestyle. Symptoms of a crisis develop more slowly, but very intensely. The headache worsens over the course of several hours. Nausea, vomiting, lethargy appear, vision and hearing deteriorate. The pulse is tense, but not rapid; Blood pressure is sharply increased, predominantly diastolic (up to 140-160 mm Hg).

A complicated hypertensive crisis can occur in the cerebral, coronary or asthmatic variant. In contrast to an uncomplicated hypertensive crisis, in complicated versions of the crisis, acute coronary insufficiency, acute left ventricular failure (cardiac asthma, pulmonary edema), and acute cerebrovascular accident (hypertensive encephalopathy, transient cerebrovascular accident or stroke) can develop against the background of high blood pressure.

If a hypertensive crisis develops, especially a complicated one, it is necessary to call an ambulance.

First aid for a hypertensive crisis consists of immediately taking the following set of measures.

Provide the patient with complete rest. It is contraindicated for him to walk or engage in any physical activity; he needs to be placed in a comfortable semi-sitting position with the help of pillows. If the attack occurred on the street, you need to place folded clothes and other available means under his back. The head should always be higher than the level of the body to prevent increased blood flow and reduce the load on the blood vessels of the brain.

Reduce the brightness of the lighting near the patient and, if possible, ensure maximum silence and the absence of external stimuli. Those around you should behave calmly and not give in to panic, as nervousness is instantly transmitted to the patient.

Since a crisis makes breathing difficult, it is necessary to unbutton tight clothing, loosen your collar, scarf, tie, etc. If the patient is indoors, then you need to provide him with a flow of fresh air, but it is important to ensure that he does not catch a cold.

The victim’s legs need to be warmed well: apply a heating pad, a plastic bottle with hot water to them, you can put mustard plasters on the calf muscles.

Check with the patient whether he suffers from high blood pressure, what medications the doctor has prescribed for him to lower it, and give him this medicine. If the pressure does not decrease within an hour, the drug must be taken again, but care must be taken not to reduce the pressure too much - this can provoke loss of consciousness and further complicate the patient’s condition, especially in the elderly.

If it is impossible to give the patient his usual medicine or if he has not previously taken antihypertensive drugs at all, he can be given a Nifedipine 10 mg tablet (but only if he does not have severe tachycardia and angina). The drug effectively reduces blood pressure. If there is heart disease or information about the patient’s intolerance to nifedipine, the drug can be replaced with captopril 12.5-25 mg; it normalizes blood pressure, protects the heart and prevents the development of nephropathy. In addition, unlike nifedipine, captopril does not cause drowsiness, dizziness and tachycardia. In case of hypertensive crisis of the first type, it is advisable to use anaprilin 40 mg orally or sublingually in crushed form. For type 2 hypertensive crisis, diuretics are used, for example, furosemide 20-40 mg.

It is advisable to give the patient 40 drops of Corvalol to relieve anxiety, panic and fear of death, which usually affects a person in a state of hypertensive crisis. Instead of Corvalol, valocordin, tincture of valerian or motherwort are suitable.

For heart pain, give the patient validol or nitroglycerin, but the latter must be used very carefully: it dilates blood vessels and can provoke collapse.

If possible, you should organize blood pressure monitoring, record tonometer readings, pulse and breathing rates every 15-20 minutes until the doctor arrives.

Some patients mistakenly believe that quickly lowering blood pressure to normal levels will help quickly get rid of the symptoms accompanying a hypertensive crisis. Under no circumstances should you sharply reduce blood pressure; this can lead to collapse, accompanied by loss of consciousness. In severe cases, this can lead to the development of ischemic changes in the brain and other organs as a result of depletion of blood flow.

Health care workers stop a hypertensive crisis, guided by medical protocol. It describes the standard of care for each specific disease. Patients with an intractable or complicated hypertensive crisis, as well as patients with an uncomplicated but new-onset hypertensive crisis, after providing them with emergency medical care, should be hospitalized in a cardiology or therapeutic department.

Use in hazardous conditions

If an uncomplicated hypertensive crisis occurs, the patient needs to take Capoten correctly. To achieve a quick therapeutic effect, it is better to place 1 tablet under the tongue. When absorbed, the active substance quickly penetrates the systemic bloodstream and begins to act. After complete resorption, you need to measure blood pressure and monitor your heart rate (pulse) every hour. If the pressure has not decreased within half an hour, take 1 tablet again.

It is strictly prohibited to exceed the daily dose of 50 mg; if there is no effect after 2 tablets, intravenous administration of other antihypertensive drugs is prescribed.

For chronic heart failure, the initial dosage is 6.25-12.5 mg in the morning and evening. Then increase to 15-150 mg per day (depending on the severity of the condition and individual tolerance to the chemical).

The first day after myocardial infarction - test dose of 6.25 mg. If the dynamics are positive, take 12.5 mg after 2 hours, and 25 mg after 12 hours. On the second day and the entire subsequent month, take 100 mg, divided into two doses, morning and evening.

For left ventricular dysfunction - 6.25 mg once every day. On the second day - 12.5 mg 3 times. From day 3 and for several weeks - 1 tablet. 3 times a day. The maximum permissible dose for severe forms is 2 tablets. 2-3 times a day.

Reception features

Most patients with hypertension are interested in the question of what is the difference between medications if they have the same effect.

Tablets should be taken with plenty of purified water.

The first thing the patient notes is the cost of the pills. Capoten belongs to an expensive group of drugs, while Captopril is 3-4 times cheaper. In addition, hypertension is a chronic disease that requires constant use of antihypertensive drugs. Due to long-term use of one of the drugs, the body may become addicted when there is no therapeutic effect after using them. Therefore, experts recommend periodically replacing one remedy with another.

The rules for taking pills are as follows:

• You need to take the tablets 60 minutes before your main meal.
• The tablet must be taken as a whole.
• The dose and duration of the therapeutic course are prescribed by a specialist depending on the stage of the pathological process, the age category of the patient and the presence of concomitant diseases.
• The minimum dose of the drug is ¼ of a 25 mg tablet.
• The dosage is increased after 2-3 weeks until the therapeutic effect is fully achieved.
• The daily dose should not exceed 300 mg.
• It is necessary to constantly monitor the condition of the excretory system.
• At the beginning of treatment, it is necessary to monitor the number of leukocytes in the blood.

Increasing the maximum daily dose of a drug does not increase its effectiveness, but only causes adverse reactions in the body.

Side effects of antihypertensive drugs

According to numerous observations and studies in clinical practice, the difference between Capoten and Captopril lies in tolerability. Capoten has minimal negative effects on the body. It is better tolerated by older people and patients with chronic diseases of vital organs.

Side effects of Capoten (appear only in 3% of cases):

• dry cough, sore throat;
• drying of the oral mucosa;
• rapid pulse;
• dizziness;
• rash on the body.

Negative phenomena when taking Captopril often occur due to non-compliance with treatment regimens and regular overdose. The consequences of incorrect dosing can cause the following dangerous conditions:

• cardiogenic shock, up to cardiac arrest;
• dry cough, pneumonia, bronchospasm leading to suffocation;
• vomiting due to stomach irritation, the appearance of ulcers on the mucous membrane, pain in the epigastric region, inflammation of the pancreas;
• bile stagnation, jaundice, liver inflammation;
• violation of the quantitative and qualitative composition of blood;
• increasing the acidity of the body’s internal environments;
• sleep disturbance, muscle pain, blurred vision.

Mental disorders are observed - psycho-emotional stress, stress, depression, tearfulness. There have been cases of the development of drug-induced anorexia - complete lack of appetite, irreversible changes in metabolism, sudden weight loss.

Side effects

Extraneous reactions occur in all organs:

Compatibility with other drugs

Capoten and Captopril can be prescribed together with other drugs to lower blood pressure. For heart attacks, the use of drugs with Nitroglycerin is allowed, subject to a minimum dosage. Patients with hypertension are prescribed diuretics as part of complex treatment. Diuretics in large doses reduce the volume of circulating blood and can provoke persistent hypotension. Strong alcoholic drinks cause vasoconstriction. Concomitant use of alcohol with cardiovascular drugs causes serious consequences - persistent hypertension, vascular insufficiency, heart attack, risk of sudden death.

Concomitant use with antipsychotics and antidepressants increases the risk of developing orthostatic collapse - insufficient blood flow to the brain due to low blood pressure. Adrenaline, Ephedrine, Norepinephrine reduce the effectiveness of captopril. Psychotropic drugs for the treatment of manic states, when taken simultaneously with antihypertensive drugs, increase the toxic effect on the myocardium.

What is the difference?

In search of an answer to the question: “Are Capoten and Captopril the same thing or not?” It is worth taking a closer look at the composition of these medications. It is he who gives an understanding of the difference between them.

Captopril or Capoten, the difference between which is not so obvious, differ in the excipients included in the composition. They do not have a significant effect on the effects of the drugs. However, they can provoke some side effects.

The toxicity of these substances is very conditional. In particular, the ability of talc to provoke the development of malignant tumors when taken orally has not yet been fully proven by modern science. However, some women who use talc in powders develop cancer. Whether its use led to the development of a tumor, or whether it was the malignancy that made the use of additional hygiene products necessary is unknown. Capoten uses corn starch instead of talc. This substance is considered a more preferable and safe component.

It is the costs of purification that primarily explain the price difference between the drugs. The average market price of Capoten is approximately 10 times higher than the cost of Captopril.

In addition, the price is related to the brand. So Kapoten is a name officially registered in the USA. Captopril is produced in many countries: Russia, India, CIS.

• List of drops for high and low blood pressure

Why is hypertension dangerous?

Analogues of Capoten and Captopril

Drugs with similar effects may differ in the form of release and the active substance on the basis of which the medicine is produced. But all drugs belong to the group of drugs for the treatment of diseases of the cardiovascular system. They have one code in the anatomical-therapeutic-chemical classification - ATC-C.

Some substitutes are more effective in lowering blood pressure. This is due to their prolonged action. Imported drugs are taken once a day, which eliminates missed doses and violations of the treatment regimen (elderly patients often forget to take a pill at the right time if prescribed 2-3 times a day).

The choice in favor of Capoten or Captopril should be determined by the attending physician - therapist, cardiologist. Uncontrolled or self-treatment with drugs that lower blood pressure can lead to serious consequences - myocardial infarction, death.

Differences between drugs

Despite the similarity of medications, there are some differences between them.

The pharmaceutical market and experts are unanimous in the opinion that Capoten is a more effective drug, but a comparative analysis of these medications has not been carried out. The tablets differ only in the auxiliary components that are included in their composition. Thus, Capoten contains special additives that reduce the risk of side effects. It is covered with a cellulose shell, which, once it enters the digestive tract, dissolves and is absorbed faster. Capoten is considered a foreign product, since it is officially registered in the United States, while its analogue Captopril is produced in India and Russia.

Both medications are widely used as emergency treatments during a crisis, but their main goal remains complex therapy of the cardiovascular system.