enalapril and Edema

Patients (pts) with stable coronary artery disease (CAD) can benefit from a decrease in the blood pressure (BP), according to recent studies.. To evaluate the efficacy and tolerability of the fixed combination: amlodipine + enalapril, when compared to amlodipine in the normalization of the diastolic arterial pressure (DAP) (<85 mmHg), in pts with CAD and systemic arterial hypertension (SAH).. Double-blind and randomized study, with two groups of pts with DAP > or =90 and <110 mmHg and CAD. Patients with left ventricular ejection fraction (LVEF) < 40%, symptoms of heart failure or angina class III and IV, severe diseases and DAP > or =110 mmHg during the four-week wash-out with atenolol treatment alone, were excluded. After the wash-out, pts were randomly distributed for the use of the combination (A) or amlodipine (B) and were followed every four weeks up to 98 days. The initial doses (in mg) were, respectively: A- 2.5/10 and B- 2.5; the doses were increased when DAP > 85mmHg, at the visits. Statistical analysis was carried out with chi2, Fischer and analysis of variance, for p< 0.05.. Of the 110 selected pts, 72 (A= 32, B= 40) were randomized. The decreases in DAP and systolic arterial pressure (SAP) were significant (p< 0.01), but with no difference between the groups in mmHg: SAP, A (127.7 +/- 13.4) and B (125.3 +/- 12.6) (p= 0.45) and DAP, A (74.5 +/- 6.7 mmHg) and B (75.5 +/- 6.7 mmHg) (p= 0.32). Group A presented a lower incidence of lower-limb edema: (7.1% vs 30.6%, p=0.02) on the 98th day of follow-up.. The fixed combination of enalapril and amlodipine, as well as isolated amlodipine, was effective in the normalization of BP in pts with CAD and SAH stages I and II, adding blockage of the renin-angiotensin system.

Topics: Amlodipine; Antihypertensive Agents; Blood Pressure; Coronary Disease; Drug Therapy, Combination; Edema; Enalapril; Epidemiologic Methods; Female; Humans; Hypertension; Lower Extremity; Male; Middle Aged

Calcium channel blockers (CCBs) blunt postural skin vasoconstriction, an autoregulatory mechanism that minimizes gravitational increases in capillary pressure and avoids fluid extravasation when standing. To evaluate the dose-response relation between this pharmacological interference and dependent edema, a frequent side effect of CCBs during antihypertensive treatment, skin blood flow (laser Doppler flowmetry) at the dorsum of the foot, both supine and with the limb passively placed 50 cm below the heart level, and leg weight (Archimedes principle) were measured at baseline, during increasing doses of the dihydropyridine amlodipine (5 and 10 mg UID each for 2 weeks), and after drug withdrawal in 10 hypertensive men. Because angiotensin-converting enzyme inhibitors may attenuate ankle swelling by CCBs, those parameters were evaluated according to a similar design during amlodipine (10 mg UID) and enalapril (20 mg UID) combined (n=10). As a control, the effect of enalapril monotherapy (10 and 20 mg UID for 2 weeks each) was evaluated in a third series of patients (n=8). Amlodipine (5 mg UID) increased leg weight without modifying postural vasoconstriction (the percent skin blood flow decrease from horizontal to dependent position), which indicates that extravascular fluid shift was independent of postural skin vasoconstriction. At 10 mg UID, however, amlodipine blunted postural vasoconstriction and increased leg weight further, which suggests that skin blood flow autoregulation limited additional fluid transfer. Both parameters normalized after drug withdrawal. Enalapril per se did not affect cutaneous vasomotion or leg weight but reduced the amount of dependent fluid extravasation by the CCB despite a persistent antagonism for postural vasoconstrictor responses.

Topics: Adult; Aged; Amlodipine; Antihypertensive Agents; Blood Pressure; Diastole; Dose-Response Relationship, Drug; Edema; Enalapril; Humans; Hypertension; Laser-Doppler Flowmetry; Leg; Male; Middle Aged; Organ Size; Regional Blood Flow; Skin; Statistics as Topic; Systole; Treatment Outcome

The aim of this study was to compare the tolerability and efficacy of isradipine and felodipine in the treatment of mild-moderate hypertension. After a 4 week placebo period, 143 patients entered a randomized, double-blind, multicentre study of 12 weeks duration. Patients received either isradipine (n = 72) or felodipine (n = 71) 2.5 mg twice daily. Doubling of this dose and the addition of enalapril (2.5 mg once daily) was permitted if DBP was > 90 mmHg at weeks 4 and 8, respectively. Isradipine monotherapy reduced BP from 165/104 +/- 13/6 mmHg at baseline to 149/91 +/- 14/10 mmHg at week 8 (p < 0.001), while felodipine alone reduced BP from 171/104 +/- 17/6 at baseline to 151/92 +/- 19/9 (p < 0.001). Following the addition of enalapril to 35% of patients in the isradipine group BP was further reduced to 144/88 +/- 13/8 mmHg at week 12 (p < 0.001). The addition of enalapril to 24% of the felodipine group further reduced BP to 150/92 +/- 19/9 mmHg at week 12 (p < 0.001). No differences in BP were found between the 2 groups while on monotherapy. However, the isradipine group had a significantly lower DBP than the felodipine group at the conclusion of the study (p = 0.008; 95% CI 0.7 to 6.9 mmHg). Similar incidences of headache, flushing, dizziness and tachycardia were reported in both groups. However, the incidence of ankle oedema was significantly lower in the isradipine group (p = 0.028). Overall, ankle oedema was reported more often by female patients and was not associated with an increase in weight.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Aged; Ankle; Blood Pressure; Double-Blind Method; Drug Tolerance; Edema; Enalapril; Felodipine; Female; Heart Rate; Humans; Hypertension; Isradipine; Lipids; Male; Middle Aged

The objective of this study was to compare the tolerability of isradipine and felodipine in patients with mild-to-moderate hypertension. Following a 4-week placebo run-in, 143 patients entered a 12-week double-blind multicenter study. Patients were randomized to receive either isradipine (n = 72) or felodipine (n = 71) at a dose of 2.5 mg twice daily. Dose-doubling and the addition of enalapril (2.5 mg once daily) was permitted if diastolic blood pressure (DBP) was > 90 mm Hg at weeks 4 and 8, respectively. Isradipine reduced blood pressure from 165/104 +/- 13/6 mm Hg at baseline to 144/88 +/- 13/8 mm Hg at week 12 (P < .001) whereas felodipine reduced blood pressure from 171/104 +/- 17/6 mm Hg at baseline to 150/92 +/- 19/9 mm Hg at week 12 (P < .001). Similar incidences of headache, flushing, dizziness and tachycardia were reported in both groups. However, the incidence of ankle edema was significantly lower in the isradipine group (14% v 30%) (P = .028). It is concluded that isradipine represents a practical improvement over felodipine in the treatment of hypertension.

Topics: Adult; Ankle; Double-Blind Method; Drug Therapy, Combination; Edema; Enalapril; Felodipine; Female; Headache; Humans; Hypertension; Isradipine; Male; Middle Aged; Treatment Outcome

Angiotensin converting enzyme inhibitors (ACEi) are widely used for the treatment of multiple conditions such as hypertension, heart failure and chronic kidney disease. Angioedema is a rare but potentially fatal complication of ACEi use and unilateral tongue edema is a very rare presentation. We report a case of a 55-year-old man, with a history of hypertension, on enalapril for three years, who presented to the hospital with unilateral tongue swelling, without airway compromise. Other causes were excluded and the diagnosis of angioedema due to enalapril was established. The patient was discharged with discontinuation of ACEi with total resolution of symptoms and without relapse after several months. Although very rare, unilateral tongue swelling should be considered in the presentation of angioedema associated with ACEi. Tight surveillance is important to prevent fatal complications such as airway obstruction. ACEi discontinuation is crucial to avoid clinical relapse.. Os inibidores da enzima de conversão da angiotensina (iECAs) são amplamente usados no tratamento de várias patologias como a hipertensão arterial, insuficiência cardíaca e doença renal crónica. O angioedema é uma complicação rara mas potencialmente fatal desta medicação e o edema unilateral da língua é uma apresentação rara desta condição. Reportamos o caso de um homem de 55 anos com hipertensão, medicado há três anos com enalapril, que à admissão hospitalar apresentava edema unilateral da língua sem compromisso da via aérea. Outras etiologias foram excluídas, tendo-se assumido o diagnóstico de angioedema associado ao enalapril. Após suspensão do iECA os sintomas diminuíram progressivamente, sem recorrência do quadro após vários meses. Ainda que raro, o edema unilateral da língua deve ser considerado na apresentação do angioedema associado a iECA. É importante uma vigilância apertada para prevenir complicações fatais, tais como a obstrução da via aérea. A descontinuação do iECA é fundamental para evitar recidiva.

Topics: Angioedema; Angiotensin-Converting Enzyme Inhibitors; Edema; Enalapril; Humans; Hypertension; Male; Middle Aged; Mouth Diseases; Recurrence; Tongue; Tongue Diseases

Topics: Child, Preschool; Cognitive Dysfunction; Edema; Enalapril; Female; Growth Disorders; Human Growth Hormone; Humans; Hypertension; Nephrotic Syndrome; Severity of Illness Index

Topics: Antihypertensive Agents; Diuretics; Echocardiography; Edema; Enalapril; Furosemide; Heart Failure; Humans; Male; Pneumonia, Mycoplasma; Pulmonary Heart Disease; Treatment Outcome; Tricuspid Valve Insufficiency; Tuberculosis, Pulmonary

Chemosis is a rare and reversible complication of nephrotic syndrome in children. However, it is not a threatening condition as there are no complications of its own. We report a 15-year-old girl with steroid-resistant nephrotic syndrome with bilateral chemosis recovering along with the disappearance of the anasarca.

Topics: Adolescent; Albumins; Angiotensin-Converting Enzyme Inhibitors; Conjunctival Diseases; Cyclosporine; Diuretics; Edema; Enalapril; Female; Glucocorticoids; Humans; Immunosuppressive Agents; Nephrotic Syndrome; Prednisone

Topics: Adult; Antihypertensive Agents; Atorvastatin; Diuretics; Drug Therapy, Combination; Edema; Enalapril; Follow-Up Studies; Heptanoic Acids; Humans; Hydrochlorothiazide; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hypertension; Knee; Male; Pituitary ACTH Hypersecretion; Pyrroles; Sodium Chloride Symporter Inhibitors

Topics: Adult; Dose-Response Relationship, Drug; Drug Therapy, Combination; Edema; Enalapril; Ephedrine; Female; Humans

Two angiotensin converting enzyme (ACE) inhibitors, trandolapril and enalapril, were compared for their effects on rat food-pad oedema induced by carrageenin, bradykinin, dextran and platelet activating factor (PAF). Trandolapril (0.03-30.0 mg/kg, per os) potentiated carrageenin-induced oedemas. Enalapril produced the same effect at 3-10 fold higher doses (0.3-30.0 mg/kg per os). Both ACE inhibitors were equiactive in potentiating bradykinin-induced oedema. Neither compound affected dextran-induced oedema. In marked contrast PAF-induced oedema was reduced by both ACE inhibitors, trandolapril being approximately 10 fold more active than enalapril. The observed differences in potency between the two ACE inhibitors corresponded with their previously described actions on inhibition of plasma and tissue ACE and in inducing hypotension. The results suggest a crucial role of kinins in the oedemagenic response to carrageenin. The reason why the ACE inhibitors reduced PAF-induced oedema is not clear, but could involve peripheral vasodilation.

Topics: Animals; Bradykinin; Carrageenan; Dextrans; Edema; Enalapril; Foot; Indoles; Male; Platelet Activating Factor; Rats; Rats, Inbred Strains

Topics: Adult; Edema; Enalapril; Female; Humans; Intestinal Diseases; Intestinal Mucosa

Topics: Aged; Antihypertensive Agents; Dipeptides; Edema; Enalapril; Eosinophilia; Humans; Hyperkalemia; Male; Pruritus