enalapril and Lupus-Erythematosus--Systemic

The aim of this study was to compare the efficacy of intravenous cyclophosphamide (IVCYC) versus oral enalapril in mild or moderate pulmonary hypertension (PH) in systemic lupus erythematosus (SLE). Thirty-four patients with SLE who had systolic pulmonary artery pressure (SPAP) > 30 mmHg by Doppler echocardiography were randomized to receive IVCYC (0.5 g/mt2 body surface area, monthly), or oral enalapril (10 mg/day) for six months. The primary outcome was the significant decrease in SPAP. An additional outcome measure included the improvement in the heart functional class (NYHA). Sixteen patients received cyclophosphamide and 18 enalapril. IVCYC decreased the median values of SPAP from 41 to 28 mmHg (P < 0.001), and enalapril from 35 to 27 mmHg (P = 0.02). IVCYC reduced more than twice as much SPAP than enalapril (P = 0.04). In those patients with SPAP > or = 35 mmHg, cyclophosphamide decreased from 43 to 27 mmHg (P = 0.003), but enalapril was not effective (P = 0.14). The NYHA functional class improved only in those with cyclophosphamide (P = 0.021). Also IVCYC had a higher frequency of side effects including infections (RR = 1.6; 95% CI, 1.001-2.47), and gastrointestinal side effects (RR = 14.6; 95% CI, 2.15-99.68). We concluded that IVCYC was effective in mild and moderate PH associated with SLE. Further research is needed to evaluate its long-term efficacy.

Topics: Administration, Oral; Adolescent; Adult; Cyclophosphamide; Enalapril; Humans; Hypertension, Pulmonary; Injections, Intravenous; Lupus Erythematosus, Systemic; Middle Aged; Pulse Therapy, Drug; Treatment Outcome; Ultrasonography

Angioedema is a rare but potentially fatal side effect of angiotensin converting enzyme (ACE) inhibitors. We report for the first time, two children with systemic lupus erythematosus who developed acute angioedema after the long-term use of enalapril. Prompt recognition and appropriate management of ACE-induced angioedema prevented life-threatening complications. This report highlights the potential risks of angioedema associated with the use of ACE inhibitors in children. Patients should be advised to seek medical treatment immediately if they experience swelling of the face, neck, or tongue, and especially if they have trouble breathing, speaking, or swallowing.

Topics: Adolescent; Angioedema; Angiotensin-Converting Enzyme Inhibitors; Child; Enalapril; Female; Humans; Lupus Erythematosus, Systemic; Male

Topics: Aged; Angiotensin-Converting Enzyme Inhibitors; Atrial Fibrillation; Enalapril; Humans; Hypertension; Lisinopril; Lupus Erythematosus, Systemic; Male; Mitral Valve Insufficiency

We have previously demonstrated that Captopril, an inhibitor of angiotensin converting enzyme (ACE), ameliorates experimental systemic lupus erythematosus in inbred MRL lpr/lpr (MRL/l) mice. In contrast, Enalapril, another ACE inhibitor with antihypertensive properties but lacking a thiol group, did not show similar beneficial effects. To better understand the mode of action of captopril in the autoimmune disease we have evaluated its immunomodulatory properties with special emphasis on antigen-specific and polyclonal B- and T-cell activation. The results obtained strongly suggest that Captopril exerts its immunomodulatory effects through stimulation of T-lymphocytes.

Topics: Angiotensin-Converting Enzyme Inhibitors; Animals; Antibody Formation; B-Lymphocytes; Captopril; Concanavalin A; Enalapril; Interleukin-2; Lupus Erythematosus, Systemic; Mice; Mice, Inbred Strains; T-Lymphocytes

We describe the use of fludrocortisone in a patient with systemic lupus erythematosus, who initially presented with moderate renal insufficiency, high serum potassium, metabolic acidosis, low urine pH, and a high urinary anion gap indicating tubular dysfunction. Renal histology revealed membranous glomerulonephritis and interstitial inflammation. During the course of the disease the patient developed persistent severe hyperkalemia. Dietary potassium restriction and therapy with diuretics combined with cation exchange resins failed to decrease potassium levels sufficiently. Drug therapy including cyclosporin A, enalapril, atenolol, phenytoin, necessary to control active disease and severe hypertension contributed to elevated potassium levels. Effective correction of hyperkalemia was achieved by fludrocortisone treatment. We conclude that fludrocortisone is a potent therapeutic approach for selected patients suffering from life threatening hyperkalemia, in whom potassium elevating drugs cannot be withdrawn.

Topics: Adolescent; Atenolol; Creatinine; Cyclosporins; Enalapril; Fludrocortisone; Humans; Hyperkalemia; Kidney; Lupus Erythematosus, Systemic; Male; Phenytoin; Potassium; Renin-Angiotensin System

Persistent anuria was diagnosed in a neonate born to a mother whose pregnancy was complicated by severe hypertension and systemic lupus erythematosus. Severe maternal hypertension necessitated the use of a battery of antihypertensive medications that included enalapril, an angiotensin converting enzyme inhibitor. The role of enalapril in neonatal renal failure is discussed.

Topics: Acute Kidney Injury; Antihypertensive Agents; Anuria; Drug Therapy, Combination; Enalapril; Female; Humans; Hyaline Membrane Disease; Hypertension; Infant, Newborn; Kidney; Lupus Erythematosus, Systemic; Male; Pregnancy; Pregnancy Complications

The MRL/1 and New Zealand black-New Zealand white cross (NZB x W) mice spontaneously develop a disease similar to systemic lupus erythematosus in man. The effect of antihypertensive treatment on MRL/1 and NZB x W mice was studied with respect to survival, blood pressure, proteinuria, haematuria and renal histopathology. The treatment consisted of angiotensin converting enzyme (ACE) inhibitors (captopril and enalapril) and bretylium, a sympathetic blocker. Tail systolic blood pressure was measured with a strain gauge technique. All antihypertensive drugs caused a reduction in blood pressure in both strains. In MRL/1 bretylium and both ACE inhibitors improved renal histopathology, but only captopril prolonged survival, and it decreased proteinuria and haematuria. In NZB x W captopril decreased proteinuria but did not influence survival or renal histopathology. Bretylium was without any effect on these parameters. At the doses used captopril improves survival in MRL/1 mice and decreases proteinuria and haematuria in both MRL/1 and NZB x W mice. Since bretylium and enalapril lack this property despite a similar blood pressure reduction, it seems to be a drug-specific action.

Topics: Animals; Blood Pressure; Bretylium Compounds; Captopril; Enalapril; Hypertension; Lupus Erythematosus, Systemic; Mice; Mice, Mutant Strains