Trandolapril is a new angiotensin converting enzyme (ACE) inhibitor that effectively lowers blood pressure in doses up to 2 mg. Only a small additional effect is seen with higher doses. The drug is transformed in vivo to the active metabolite trandolaprilat. When renal function is severely impaired a dose reduction may be necessary because the clearance of trandolaprilat is significantly correlated to creatinine clearance. Trandolapril has a sustained action that is reflected in long-lasting inhibition of ACE, even after discontinuation of treatment. Blood pressure is controlled by the drug in about 60% of patients with a side effect profile that is comparable to that of the other ACE inhibitors. Trandolapril can be given safely over a prolonged period of time.
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