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Enalapril lowers blood pressure by blocking the conver-sion of angiotensin I to angiotensin II (ANG II). Since converting enzyme also inactivates bradykinin, enalapril increases bradykinin levels, and this is responsible for adverse side effects such as cough and angioedema. This problem might be avoided by using a renin inhibitor, eg, aliskiren, or an ANG II receptor antagonist, eg, valsartan, instead of an angiotensin-converting enzyme inhibitor, to block the renin-angiotensin system. A β-adrenoceptor-blocking drug might also be tried since, in addition to their cardiac action, these drugs can inhibit renin secretion.
The Eicosanoids:
Prostaglandins, Thromboxanes, Leukotrienes, & Related Compounds
John Hwa, MD, PhD, & Kathleen Martin, PhD* pulmonary pressures, and right ventricular enlargement. Cardiac catheterization confirmed the severely elevated pulmonary pressures. She was commenced on appropri-ate therapies. Which of the eicosanoid agonists have been demonstrated to reduce both morbidity and mortality in patients with such a diagnosis? What are the modes of action? A 40-year-old woman presented to her doctor with a 6-month history of increasing shortness of breath. This was associated with poor appetite and ankle swell-ing. On physical examination, she had elevated jugular venous distention, a soft tricuspid regurgitation murmur, clear lungs, and mild peripheral edema. An echocardio-gram revealed tricuspid regurgitation, severely elevated