Antihypertensive drug-angiotensin converting enzyme

Before you write an article, let’s understand the concept. What is angiotensin?

Angiotensin is also called angiotensin. As the name implies, it acts to contract blood vessels. It is not difficult to imagine that angiotensin constantly shrinks blood vessels, so it causes an increase in blood pressure. At this time, you want to lower your blood pressure. It also finds a drug to inhibit (that is, to block, weaken) the role of angiotensin, that is, we often hear angiotensin-converting enzyme inhibitors, antihypertensive drugs with the word “Puli” The drugs belong to this category.

 Antihypertensive drug-angiotensin converting enzyme

The role of angiotensin converting enzyme

1. Angiotensin is divided into angiotensin I and angiotensin II. Angiotensin I has a certain effect on blood pressure, but the effect is not obvious. Angiotensin II has a strong effect on blood pressure, so the blood vessels are tight. The enzyme-converting enzyme inhibitor mainly inhibits the conversion of angiotensin I to angiotensin II, and achieves the purpose of lowering blood pressure. In addition, angiotensin-converting enzyme inhibitors can also inhibit the degradation of bradykinin, thereby dilating blood vessels, lowering blood pressure, reducing cardiac afterload, and protecting the function of drug treatment targets. Angiotensin-converting enzyme inhibitors are the only ones. Dual system protectant.

The two systems mentioned here are only the renin-angiotensin-aldosterone system (RAAS) and kallikrein kinin system.

antihypertensive drug - angiotensin converting enzyme

2. Angiotensin-converting enzyme inhibitors can also improve left ventricular function. For heart failure, reduce pulmonary capillary wedge pressure, reduce cardiac filling pressure, increase stroke volume, and increase left ventricular ejection fraction. And heart index, can delay the wall of the blood vessels and ventricular wall hypertrophy.

3. Angiotensin-converting enzyme inhibitors can dilate arteriovenous, reduce the resistance of peripheral blood vessels and coronary and renal artery resistance, increase coronary blood flow, increase the volume of the venous bed, and thus return the blood volume. Reduced, decreased pre-cardiac stress, slowed by high blood pressure caused by renal artery occlusion

antihypertensive drug - angiotensin converting enzyme

solution, at the same time increase renal blood flow, increase glomerular filtration rate, is conducive to the excretion of urinary sodium, reduce the total amount of body fluids, and also help improve left ventricular function.

4. Angiotensin-converting enzyme inhibitors can scavenge oxygen free radicals and regulate blood lipids, which can lower cholesterol (CH) and triglyceride (TG) in plasma, and high-density lipoprotein (HLD-ch) ) elevated or substantially unchanged.

5. Angiotensin-converting enzyme inhibitors can also improve renal function and cause acute renal failure and hyperkalemia, but as long as renal perfusion is sufficient and fluid loss is not severe, angiotensin-converting enzyme inhibition The agent improves renal blood flow, further improves the salt secretion of the kidney, and slows down the development of chronic kidney disease and kidney damage.

As the saying goes, it is a three-point drug. Although angiotensin-converting enzyme inhibitors have many therapeutic effects, there are also many adverse reactions:

common The adverse reactions were dry cough, the incidence rate was about 20%, upper respiratory symptoms (rhinitis), chest pain, serum creatinine and urea nitrogen and proteinuria, taste disorder (with metallic taste), angioedema.

 Antihypertensive drug - angiotensin converting enzyme

The following population cannot use angiotensin converting enzyme inhibition Agents

pregnant women, hyperkalemia, bilateral renal artery stenosis, arterial stenosis, history of angioedema.

Angiotensin-converting enzyme inhibitors can interact with the following drugs

1. Non-steroidal anti-inflammatory drugs (aspirin, diclofenac, ibuprofen, indomethacin, etc.) The drug can reduce the effect of angiotensin-converting enzyme inhibitors on dilating blood vessels, thereby reducing the antihypertensive effect, so it should not be combined if not necessary.

2. Potassium salts or low-salt substitutes containing high potassium. Potassium diuretics (mainly used in the clinic, mainly spironolactone) can aggravate hyperkalemia caused by angiotensin-converting enzyme inhibitors. Because both types of drugs are potassium, which leads to elevated blood potassium, it is not suitable for use. When there is an increase in serum potassium, it can also be combined with potassium diuretics (furosemide and hydrochlorothiazide are commonly used in clinical practice. Furosemide is more toxic, and renal insufficiency should not be used).

 Antihypertensive drug-angiotensin converting enzyme

3. When combined with human erythropoietin May affect the erythropoietin erythropoiesis effect

The commonly used angiotensin-converting enzyme inhibitors are as follows:

Cappopril

Antihypertensive drug - angiotensin converting enzyme

Indications: for high blood pressure, Heart failure, hypertensive emergency

Notes:

1Use caution and attention when monitoring renal insufficiency; hyperkalemia or other adverse reactions are more likely to occur, the initial dose is 12.5 Mg, twice a day.

2 This product can be secreted from milk, and lactating women need to weigh the pros and cons. Pregnant women should not be used, there are reports of fetal stillbirth, teratogenicity and intrauterine growth retardation.

3If there are autoimmune diseases such as severe systemic lupus erythematosus, inhibition of bone marrow function, insufficient blood supply to the cerebral artery or coronary artery, hyperkalemia, renal insufficiency, aortic stenosis, severe dietary restriction Sodium salt or blood dialysis should be used with caution.

Enalapril

antihypertensive drug-angiotensin converting enzyme

Indications: for essential hypertension, renal hypertension, heart failure.

Ramipril

appears after essential hypertension, congestive heart failure, acute myocardial infarction (2-9 days) Mild to moderate heart failure, non-diabetic nephropathy, reduces the likelihood of myocardial infarction, stroke, or cardiovascular death in patients with increased cardiovascular risk.

Fusipril

antihypertensive drug-angiotensin converting enzyme

Indications: for high blood pressure, heart failure.

If you have autoimmune diseases, inhibition of bone marrow function, insufficient blood supply to the brain or coronary arteries, hyperkalemia, renal dysfunction, liver dysfunction, severe dietary restriction of sodium salt or hemodialysis treatment Use with caution.

Not recommended for children

Older patients do not need to reduce the dose

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