Captopril Etc.

The Renin-Angiotensin-Aldosterone system is responsible for long-term

regulation of blood pressure as follows:
Acts as a potent systemic vasoconstrictor.
Directly stimulates thirst centre in the CNS to promote water intake.
Stimulates synthesis and release of Aldosterone from the adrenal cortex.
Aldosterone acts on the kidney to:

Retain Na+ (and therefore water), leading to an increase in blood volume.
Stimulate release of Anti-Diuretic Hormone (ADH), also called arginine
vasopressin.
From the posterior pituitary. ADH promotes renal sodium and water
retention, thus increasing urine osmolality (concentration) via decreased
water excretion.
ADH also raises blood pressure moderately by direct vasoconstrictor
effects.
Drugs which interfere with the RAAS have various beneficial effects upon
cardiovascular structure and function, as well as well-documented effects
on lowering of blood pressure.

ACTS ON THE RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM (RAAS)


afferent arteriolar
resistance
- +
arterial pressure
Glomerular hydrostatic pressure
GFR
macula densa NaCl
renin
angiotensin II
efferent arteriolar
resistance
Proximal tubule
NaCl reabsorption
Macula densa
feedback mechanism
for autoregulation
afferent arteriolar
resistance
ACE Inhibitors.
Angiotensin-converting Enzyme Inhibitors:
Captopril
Enalapril
Lisinopril
prevent conversion of Angiotensin I to Angiotensin II
Net result:
Arterial vasodilation
Lowering of blood pressure.

Additionally, they have recently been shown to improve overall vascular
function and to reduce ischaemic events and mortality separate from their
beneficial effects upon blood pressure.

Angiotensin II Receptor Blockers - ARBs (e.g. losartin, candesartan,
valsartin) can be used as an alternative to ACE inhibitors in symptomatic
patients who are unable to tolerate ACEI. These drugs have been shown to
have a similar effect on morbidity and mortality.
Captopril
Alone and in combination with thiazide-type diuretics. - Blood pressure
lowering effects additive.
In CHF with diuretics and digitalis.
Left Ventricular Dysfunction improves survival in patients 40% ejection
fraction
Taken one hour before meals empty stomach.
Initiation of therapy - consider recent diuretic therapy and possibility of
severe salt/volume depletion.
Neutropenia / agranulocytosis has occurred, thrombocytopenia, and
pancytopenia
Rash, often with pruritus, and sometimes fever- treat with antihistamine
Flushing or pallor rare
Hypotension may occur
Tachycardia, chest pain, and palpitations [1 of 100 patients]

Dose Start 0.1 mg/kg 8 Hourly. Increase to 2 mg/kg as required.
[Less hypotension in tube fed patients if mixed with feeds]