RT Book, Section
A1 Reid, Ian A.
A2 Katzung, Bertram G.
SR Print(0)
ID 1148435280
T1 Vasoactive Peptides
T2 Basic & Clinical Pharmacology, 14e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9781259641152
LK accesspharmacy.mhmedical.com/content.aspx?aid=1148435280
RD 2024/04/18
AB CASE  STUDYDuring  a  routine  check  and  on  two  follow-up  visits,  a  45-year-old  man  was  found  to  have  high  blood  pressure  (160–165/95–100  mm  Hg).  His  physician  initially  prescribed  hydrochlorothiazide,  a  diuretic  commonly  used  to  treat  hypertension.  His  blood  pressure  was  reduced  by  hydrochlorothiazide  but  remained  at  a  hypertensive  level  (145/95  mm  Hg),  and  he  was  referred  to  the  university  hypertension  clinic.  Because  the  patient  had  elevated  plasma  renin  activity  and  aldosterone  concentration,  hydrochlorothiazide  was  replaced  with  enalapril,  an  angiotensin-converting  enzyme  inhibitor.  Enalapril  lowered  his  blood  pressure  to  almost  normotensive  levels.  However,  after  several  weeks  on  enalapril,  the  patient  returned  complaining  of  a  persistent  cough.  In  addition,  some  signs  of  angioedema  were  detected.  How  does  enalapril  lower  blood  pressure?  Why  does  it  occasionally  cause  coughing  and  angioedema?  What  other  drugs  could  be  used  to  inhibit  the  renin-angiotensin  system  and  decrease  blood  pressure,  without  the  adverse  effects  of  enalapril?