enalapril and Abdominal-Pain

Arthritis and hypertension are frequent comorbidities in the elderly hypertensive population. Nonsteroidal anti-inflammatory drugs are often used to relieve pain in arthritic patients but a side effect is sodium retention and consequent elevation of blood pressure (BP). The effect of dihydropyridine calcium blocking drugs is relatively independent of sodium intake, whereas the angiotensin-converting enzyme (ACE) inhibitors' effects can be blunted by a high-sodium diet. This study compared the effects of indomethacin with placebo in elderly patients with essential hypertension who had been controlled with amlodipine or enalapril. Indomethacin 50 mg twice daily or placebo was administered for 3 weeks in a double-blind crossover study to patients controlled with amlodipine or enalapril. The response was assessed by ambulatory BP measurement. Indomethacin raised BP and lowered pulse rates in patients taking enalapril but had little effect in patients receiving amlodipine. The difference caused by indomethacin between the two groups was 10.1/4.9 mm Hg increase in BP and a 5.6 beats/min fall in pulse in people taking enalapril. Addition of indomethacin to patients taking either drug caused a rise in weight and a fall in plasma renin. It is postulated that the effect is due to inhibition of prostaglandin synthesis, which causes sodium retention. In patients taking amlodipine, the fall in plasma renin ameliorates the effect of sodium retention on BP. In patients taking enalapril, plasma renin falls but this is not translated into an effect because of the blockage of converting enzyme. Thus, the full effect of sodium retention on BP is expressed. In patients treated with indomethacin, fewer patients may respond to ACE inhibitors. However, the major problem is the patient who intermittently takes indomethacin or other nonsteroidal anti-inflammatory drugs, which, if a person is treated by an ACE inhibitor causes BP to go out of control. In such patients amlodipine would appear to be a preferred choice to enalapril.

Topics: Abdominal Pain; Adult; Aged; Aged, 80 and over; Amlodipine; Anti-Inflammatory Agents, Non-Steroidal; Blood Pressure; Body Weight; Double-Blind Method; Drug Interactions; Dyspepsia; Enalapril; Female; Humans; Hypertension; Indomethacin; Male; Middle Aged; Nausea; Pain; Renin

Topics: Abdominal Pain; Adult; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Enalapril; Female; Glomerulosclerosis, Focal Segmental; Humans; Hypertension; Jejunal Diseases; Jejunum; Tomography, X-Ray Computed

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Abdominal Pain; Aged; Angiotensin-Converting Enzyme Inhibitors; Aspirin; Benzodiazepines; Bisoprolol; Bronchodilator Agents; Diuretics; Emergency Service, Hospital; Enalapril; Fluticasone; Frail Elderly; Furosemide; Humans; Male; Nordazepam; Pain Management; Pancreatitis; Pantoprazole; Salmeterol Xinafoate; Thyroxine; Tomography, X-Ray Computed; Ultrasonography

Cough and upper airway angioedema are well-recognized adverse reactions of angiotensin-converting enzyme inhibitor (ACEI) therapy. Visceral angioedema is an infrequent and often unrecognized complication of ACEI therapy. We describe a patient in whom the diagnosis was delayed for > 2 years. A 60-year-old woman with hypertension on treatment with enalapril presented with complaints of abdominal pain and diarrhea for 2 days. Physical examination was significant for diffuse abdominal tenderness and hypotension. Laboratory data were normal except for leukocytosis and elevated creatinine. Computed tomography (CT) of the abdomen showed diffuse small bowel wall thickening. ACEI-induced visceral angioedema was considered, enalapril was discontinued and supportive care was provided. Patient's symptoms and CT appearance improved 48 and 72 hours, respectively, after stopping enalapril. She remained symptom-free 1 year after discharge.

Topics: Abdominal Pain; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Enalapril; Female; Humans; Middle Aged; Radiography, Abdominal; Tomography, X-Ray Computed; Viscera

A 40-year-old woman presented with 3 episodes of abdominal pain. Abdominal ultrasound demonstrated edema of the small bowel. Double-balloon enteroscopy (DBE) showed diffuse swelling of the small intestine, petechial bleeding in the jejunum, and focal inflammation of the ileum. Pain and small bowel edema resolved spontaneously within 48 h during each episode. Review of the patient's history revealed that she had been started on enalapril for arterial hypertension two weeks before her first episode. Angiotensin-converting enzyme (ACE) inhibitor-associated angioedema of the small bowel was suspected and enalapril was discontinued. The patient remained symptom-free after discontinuing the ACE inhibitor. Review of the literature reveals only 11 similar cases with this case being the first to apply DBE to visualize macroscopic alterations to the small intestine. Angioedema of the intestine is a diagnostic pitfall frequently leading to prolonged diagnostic procedures and is a potential cause for abdominal pain in patients taking ACE inhibitors.

Topics: Abdominal Pain; Adult; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Diagnosis, Differential; Enalapril; Endoscopy, Gastrointestinal; Female; Humans; Hypertension; Intestine, Small; Ultrasonography

Topics: Abdominal Pain; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Enalapril; Female; Humans; Middle Aged; Recurrence; Time Factors

For more than five years, a patient suffered recurrent episodes of abdominal pain accompanied by diarrhoea, nausea and vomiting. An angiotensin converting enzyme (ACE) inhibitor causing visceral oedema was eventually implicated.

Topics: Abdominal Pain; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Enalapril; Female; Humans; Hypertension; Intestinal Diseases; Middle Aged

Hypotensive reactions to platelet transfusions performed with white cell (WBC)-reduction filters with negatively charged surfaces have been reported recently in patients taking angiotensin-converting enzyme (ACE) inhibitors. Experimental studies have shown that the filter material can activate bradykinin, which may cause symptoms in patients with reduced bradykinin catabolism. Symptomatic adverse reactions after the administration of fresh-frozen plasma (FFP) through a WBC-reduction filter have not been reported in a patient on ACE Inhibitor medication.. A 58-year-old man with congenital coagulation factor V deficiency and hypertension treated with an ACE inhibitor was admitted for rehabilitation after orthopedic surgery. On 3 consecutive days, he received FFP through a WBC-reduction filter; within minutes of the beginning of each infusion, he experienced a drop in blood pressure, facial erythema, abdominal pain, and anxiety. When the infusions were stopped, symptoms quickly abated without treatment. Multiple prior transfusions of unfiltered FFP and FFP filtered through a WBC-reduction filter made by a different manufacturer, as well as subsequent transfusions of unfiltered FFP, had not produced such reactions.. Facial flushing, hypotension, and abdominal pain after FFP administration in a patient on ACE inhibitor medication appeared to be associated with a specific type of WBC-reduction filter. This association and other reported studies suggest that special caution is warranted when patients who are treated with ACE inhibitors receive blood components administered through WBC-reduction filters capable of generating bradykinin.

Topics: Abdominal Pain; Angiotensin-Converting Enzyme Inhibitors; Enalapril; Factor V Deficiency; Humans; Hypertension; Hypotension; Male; Middle Aged; Platelet Transfusion

Topics: Abdominal Pain; Adult; Angioedema; Enalapril; Female; Humans; Intestinal Diseases