Fracturas costales simétricas asociadas a tos / Symmetrical rib fractures associated with chronic cough: report of one case

Cough may be associated with complications such as syncope, urinary incontinence, pneumothorax, and less frequently, pulmonary hernia and costal fractures. Chronic cough is a cause of rib fractures and when they occur it is likely to affect more than one rib. We report a 53 year-old obese male in treatment with enalapril 10 mg for hypertension with a dry cough lasting five months. He consulted for bilateral chest pain and a Chest X ray examination showed symmetrical fractures in the seventh left and right ribs. Enalapril was discontinued, cough and pain subsided in two weeks.

Angioedema intestinal aislado inducido por enalapril / Isolated intestinal angioedema induced by enalapril

El angioedema inducido por inhibidores de la enzima convertidora de angiotensina es una entidad poco frecuente caracterizada por edema en piel y mucosas, debido al aumento de la permeabilidad vascular provocada por la inhibición de la enzima convertidora y el subsiguiente aumento de la bradiquinina. De manera frecuente cursa con compromiso facial y de mucosas, siendo infrecuente el compromiso intestinal o de vía aérea. El angioedema intestinal puede presentarse asociado a angioedema facial o aislado, siendo este último excepcional. Cursa con episodios recurrentes de dolor, distensión abdominal y diarrea acuosa con recuperación completa en dos o tres días. Si bien es una entidad poco frecuente, el hecho de que esté asociada a fármacos utilizados con frecuencia nos hace incluirla en el diagnóstico diferencial del dolor abdominal recurrente. Presentamos un caso de angioedema intestinal aislado, asociado al uso de enalapril.

Angioedema induced by angiotensin converting enzyme inhibitors is a rare entity characterized by skin and mucosal edema, due to increased vascular permeability caused by inhibition of the converting enzyme and subsequent increase in bradykinin. It frequently presents with facial and mucosal involvement, being uncommon the intestinal or airway compromise. Intestinal angioedema may be associated with facial or isolated angioedema, the latter being exceptional. It is associated with recurrent episodes of pain, abdominal distention and watery diarrhea which complete recovery in two or three days. Although it is a rare entity, the fact that it is associated with frequently used drugs makes us include it in the differential diagnosis of recurrent abdominal pain. We report a case of isolated intestinal angioedema associated with the use of enalapril.

Angioedema por enalapril: caso clínico / Enalapril angioedema: clinical case

La prescripción de inhibidores de la enzima convertidora de angiotensina (IECA), en el manejo de la hipertensión e insuficiencia cardíaca se ha incrementado fuertemente desde su introducción en 1980. Estas drogas son consideradas seguras, pero se sabe que pueden producir angioedema severo como efecto secundarop en el 0.1 a 0.3% de los pacientes tratados. Caso clínico: paciente de sexo masculino de 57 años de edad, con diagnóstico de hipertensión arterial, tratado con Enalapril 20mg/día, desde hacía 7 días. Ingresa por guardia presentando angioedema en zona bipalpebral, bilateral; labio superior e inferior y regiones malares. No representa compromiso respiratorio. Dentro de sus antecedentes niega alergia a medicamentos y/o alimentos. Se indica como tratamiento Hidrocortisona y Difenhindramina (EV), evolucionando favorablemente, por lo que es externado indicándose Prednisona y Fexofenadina (OV). Dentro de las 48 hs. siguientes concurre a control, encontrandosé asintomático. Discusión: El mecanismo por el cual los inhibidores de la angiotensina producen angioedema no es claro pero probablemente sería por una acumulación tisular de bradiquinina. El angioedema generalmente afecta cabeza y cuello, por lo tanto la vía aérea está en riesgo. Ante un paciente con angioedema tratado con IECA, debería considerarse como primera causa a la administración del medicamento ya que la misma puede presentarse a los días, meses e incluso años de comenzado el tratamiento. Conclusión: El desafío para futuras investigaciones es identificar los subgrupos de pacientes con mayor riesgo de presentar angioedema, en quienes el riesgo de recibir terapia con IECA es mayor que el beneficio.

Prescription of angiotensin convertidara inhibitors (ACE) in the management of hypertension and heart failure has increased rapidly since its introduction in 1980. These drugs are considered to be safe, but it is known that can produce severe angioedema as side effect in 0.1 to 0.3% of treated patients. Clinical Case: A 57 years old male patient was admitted to the emergency department because angioedema in the bipalpebral and bilateral areas as well as in the upper and cheek regions. He had a diagnosis of hypertension and had been taking enalapril 20mg/day, for the previous 7 days. There was no respiratory compromise. He denied history of drug and / or food allergies. Hydrocortisone and Difenhindramina (EV) were prescribed with a favourable outcome. The patient was discharged with indications of prednisone and fexofenadine (OV). At a follow-up visit, 48 hours later, he presented no symptoms. Discussion: The mechanism by which inhibitors of angiotensin produced angioedema is unclear but would probably be by a tissue accumulation of bradykinin. Angioedema usually affects the head and neck so the airway is at risk. In patients with angioedema and ACE inhibitors treatment, IECA should be considered as first cause. It can occur days, months and even years of after the beginning of treatment. Conclusion: The challenge for future research is to identify subgroups of patients at increased risk of angioedema, in whom the risk of receiving ACE inhibitor therapy is greater than the benefit.

Terapia com inibidor da ECA com dosagens relativamente altas e risco de agravamento renal na insuficiência cardíaca crônica / ACE-inhibitor therapy at relatively high doses and risk of renal worsening in chronic heart failure

FUNDAMENTO: O efeito renoprotetor dos inibidores da ECA vem sendo questionado no caso de diminuição do volume circulante efetivo, como na insuficiência cardíaca crônica direita ou biventricular. Objetivo: Detectar os preditores clínicos de agravamento renal na população de pacientes com ICC, caracterizado por dois tipos de regime de dosagem de inibidores da ECA. MÉTODOS: De acordo com um desenho de coorte retrospectiva, seguimos dois grupos de pacientes com ICC - tanto direita quanto biventricular -, todos na classe III da NYHA, tratados com inibidores da ECA (enalapril ou lisinopril), e com fração de ejeção do ventrículo esquerdo (FEVE) < 50 por cento, por meio de distinção em sua dosagem de inibidor da ECA: média-baixa (< 10 mg por dia) ou dosagem "alta" (> 10 mg por dia) de enalapril ou lisinopril. A disfunção renal agravada (ARD) foi definida pelo aumento de Cr > 30 por cento com relação ao segmento basal. O modelo de risco proporcional de Cox foi utilizado para identificar os preditores da ARD entre as seguintes variáveis: os inibidores da ECA com "alta" dosagem, idade, FEVE basal, histórico de repetidas terapias intensivas com diuréticos de alça por via intravenosa (diurético intravenoso), diabete, Cr basal, histórico de hipertensão, pressão arterial sistólica < 100 mmHg. RESULTADOS: Cinquenta e sete pacientes foram recrutados, dos quais 15 foram tratados com inibidor da ECA com dosagem "alta". Durante um seguimento médio de 718 dias, a ARD ocorreu em 17 pacientes (29,8 por cento). Apenas o inibidor da ECA com "alta" dosagem (RR: 12,4681 IC: 2,1614 - 71,9239 p = 0,0050) e Cr basal (RR:1,2344 IC: 1,0414 - 1,4632 p = 0,0157) foi demonstrado ser preditor da ARD. Além disso, demonstrou-se que o inibidor da ECA com dosagens "altas" não previu ARD em ICC sem diurético intravenoso e ICC com diabete. CONCLUSÃO: Na ICC de classe III da NYHA, o inibidor da ECA com "altas" dosagens e um maior Cr basal foi preditor da ARD. A nefrotoxicidade relacionada com inibidores da ECA em "altas" dosagens foi aumentada com o diurético intravenoso, ao passo que, em pacientes com ICC com diabete, aquela não foi detectada.

BACKGROUND: Renoprotective effect of ACE-inhibitors has been questioned in case of decreased effective circulating volume, like in right or biventricular chronic heart failure. OBJECTIVE: To detect clinical predictors of renal worsening in CHF patient population characterized by two types of ACE-inhibitor dosing regimens. METHODS: According to a retrospective cohort design, we followed 2 groups of patients with CHF - whether right or biventricular -, all in III NYHA class treated with ACE-inhibitors (enalapril or lisinopril), and with left ventricular ejection fraction (LVEF) < 50 percent, by distinguishing them by ACE-inhibitor dosing: average-low (<10 mg per day) or "high" dose (>10 mg per day) of enalapril or lisinopril. Worsened renal failure (ARD) was defined by Cr increase >30 percent from baseline. Cox proportional hazards model was used to identify the predictors of ARD among the following variables: ACE-inhibitors "high" dose, age, basal LVEF, history of repeated intensive intravenous loop diuretic therapies (IV diur), diabetes, basal Cr, history of hypertension, systolic blood pressure < 100 mm Hg. RESULTS: 57 patients were recruited, of whom 15 were treated with ACE-inhibitor "high" dose. During a mean follow-up of 718 days, ARD occurred in 17 (29.8 percent) patients. Only ACE-inhibitor "high" dose (HR: 12.4681 C.I.: 2.1614-71.9239 p=0.0050) and basal Cr (HR: 1.2344 C.I.: 1.0414-1.4632 p=0.0157) were shown to predict ARD. Moreover, ACE-inhibitor "high" doses were shown to fail to predict ARD in both CHF without IV diur and CHF with diabetes. CONCLUSION: In III NYHA class CHF, ACE-inhibitor "high" doses and a higher basal Cr predicted ARD. Nephrotoxicity related to ACE-inhibitor "high" doses was increased by IV diur, whereas it was not detected in CHF patients with diabetes.

Pênfigo vegetante induzido por uso de enalapril / Pemphigus vegetans induced by use of enalapril

Pênfigo Vegetante foi primeiramente descrito como uma variante do pênfigo vulgar, em 1876, por Neumann. Em 1889, Hallopeau descreveu um paciente com pústulas e placas vegetantes, e sugeriu ser uma variante do Pênfigo Vegetante de Neumann. Ambos os tipos de pênfigo vegetante são caracterizados pelo desenvolvimento de placas vegetantes, especialmente, em dobras (axila, inguinal, perianal). Os autores apresentam e discutem um caso de Pênfigo Vegetante com uma clínica incomum, com ausência de acometimento de mucosas e áreas de flexão, em paciente idosa, associado ao uso de enalapril como possível desencadeador. Diagnóstico clínico e histológico sugestivos de Pênfigo Vegetante tipo Hallopeau.

Pemphigus Vegetans was first described as a variant of Pemphigus Vulgaris in 1876 by Neumann. In 1889, Hallopeau described a patient with pustules and vegetating plaques, suggesting that it would be a variant of Pemphigus Vegetans of Neumann. Both types of Pemphigus Vegetans are characterized by the development of vegetating plaques especially on skin folds (axillae, groin, perianal region). The authors present and discuss a case of Pemphigus Vegetans with an unusual clinical presentation lacking involvement of mucous membrane and flexor surfaces in an elderly female patient, associated with the use of enalapril as possible trigger factor. Clinical and histological diagnosis were suggestive of Pemphigus Vegetans of the Hallopeau type.

Bloqueo AV completo, reversible, en relación a hiperkalemia grave por enalapril y espironolactona: caso clínico / Complete atrioventricular block, reversible, related to serious hyperkalemia due to enalapril and spironolactone: case report

La hiperkalemia es una de las principales complicaciones potenciales del uso de drogas del tipo IECA, bloqueadores ARAII y antagonistas del receptor de aldosterona, en relación a su dosis, su eventual uso combinado y la función renal del paciente. A continuación se reporta el caso de un paciente de 71 años de edad, hipertenso y diabético que se encontraba en tratamiento con Enalapril 10 mg c/12 h y Furosemida 40 mg a/ 12 h, que sufre una bloqueo aurículo ventricular de 3º grado, secundario a una hiperkalemia de 8.53 mEq/l.

Combinação de anlodipino e enalaprila em pacientes hipertensos com doença coronariana / Combination of amlodipine and enalapril in hypertensive patients with coronary disease / Combinación de amlodipino y enalapril en pacientes hipertensos con enfermedad coronaria

FUNDAMENTO: Pacientes (pts) com doença coronariana (DAC) estável podem se beneficiar de menor pressão arterial (PA), conforme estudos recentes. OBJETIVO: Avaliar a eficácia e a tolerabilidade da combinação fixa anlodipino + enalaprila, comparada a anlodipino na normalização da PA diastólica (PAD) (< 85 mmHg), em pts com DAC e HAS. MÉTODOS: Estudo duplo-cego, randomizado, com dois grupos de pts com PAD > 90 e <110 mmHg e DAC. Excluímos os com FEVE < 40%; sintomas de insuficiência cardíaca ou angina classe III e IV; doenças graves e PAD > 110 mmHg durante o wash-out de quatro semanas, em uso só de atenolol. Após wash-out randomizamos para combinação (A) ou anlodipino (B) e seguimos de quatro em quatro semanas até 98 dias. As doses (mg) iniciais foram, respectivamente: A- 2,5/10 e B- 2,5, sendo incrementadas se PAD> 85mmHg, nas visitas. Estatística com χ2, Fischer e análise de variância, para p< 0,05. RESULTADOS:de 110 pts selecionados, randomizamos 72 (A= 32, B= 40). As reduções da PAD e da PA sistólica (PAS) foram intensas (p< 0,01), mas sem diferenças entre os grupos em mmHg: PAS, A (127,7 ± 13,4) e B (125,3 ± 12,6) (p= 0,45) e PAD, A (74,5 ± 6,7 mmHg) e B (75,5 ± 6,7 mmHg) (p= 0,32). Houve menos edema de membros inferiores no A (7,1% vs 30,6%, p=0,02) no 98º dia. CONCLUSÃO: A combinação fixa de enalaprila com anlodipino, tal qual anlodipino isolado, em pts com DAC e HAS estágios I e II foi eficaz na normalização da pressão, adicionando bloqueio ao sistema renina-angiotensina.

BACKGROUND: Patients (pts) with stable coronary artery disease (CAD) can benefit from a decrease in the blood pressure (BP), according to recent studies. OBJECTIVE: 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). METHODS: Double-blind and randomized study, with two groups of pts with DAP >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 >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 χ2, Fischer and analysis of variance, for p< 0.05. RESULTS: 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. CONCLUSION: 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.

FUNDAMENTO: Pacientes (pts) con enfermedad coronaria (EAC) estable pueden beneficiarse con una menor presión arterial (PA), de acuerdo con estudios recientes. OBJETIVO: Evaluar la eficacia y la tolerancia de la combinación fija amlodipino + enalapril, comparada a el amlodipino en la normalización de la PA diastólica (PAD) (< 85 mmHg), en pts con EAC y HAS. MÉTODOS: Estudio doble ciego, randomizado, con dos grupos de pts con PAD >90 y <110 mmHg y EAC. Excluimos a los pts con FEVI < 40%; síntomas de insuficiencia cardiaca o angina clase III y IV; enfermedades graves y PAD >110 mmHg durante el wash-out de cuatro semanas, en uso sólo de atenolol. Después del wash-out randomizamos para combinación (A) o amlopidino (B) y seguimos de cuatro en cuatro semanas hasta 98 días. Las dosis (mg) iniciales fueron, respectivamente: A- 2,5/10 y B- 2,5, siendo incrementadas si PAD> 85mmHg, en las visitas. Estadística con χ2, Fischer y análisis de varianza, para p< 0,05. RESULTADOS: De un total de 110 pts seleccionados, randomizamos a 72 (A= 32, B= 40). Las reducción de la PAD y de la PA sistólica (PAS) fueron intensas (p< 0,01), pero sin diferencias entre los grupos en mmHg: PAS, A (127,7 ± 13,4) y B (125,3 ± 12,6) (p= 0,45) y PAD, A (74,5 ± 6,7 mmHg) y B (75,5 ± 6,7 mmHg) (p= 0,32). Se registró menos edema de miembros inferiores en el A (7,1 por ciento vs 30,6%, p=0,02) en el 98º día. CONCLUSIÓN: La combinación fija de enalapril con amlodipino, tal como el amlodipino aislado, en pts con EAC y HAS estadios I y II fue eficaz en la normalización de la presión, agregando un bloqueo al sistema renina-angiotensina.

Efeito a curto prazo do losartan comparado ao enalapril na função ventricular esquerda e na capacidade de pacientes com insuficiência aórtica crônica grave oligo grave ou assintomáticos / Effect in short term of losartan compared with the enalapril in the left ventricular function and the physical capacity of patients with asymptomatic or minimally symptomatic chronic severe aortic regurgitation

Objetivo: analisar o efeito a curto prazo do lasartan comparado ao enalapril sobre a função ventricular esquerda em pacientes com insuficiência valvar aórtica grave, oligo ou assintomáticos, testar a segurança do lasartan nessas condições e estudar o impacto destas drogas sobre a capacidade física. Métodos: Dez pacientes com insuficiência valvar aórtica (IAo)crônica grave e com função ventricular esquerda preservada (fração de ejeção menor ou igual 0,55), foram estudados de forma prospectiva em um estudo de intervenção medicamentosa cross-over, comparando-se duas drogas: losartan e o enalapril, através de avaliação clínico-laboratorial, ecocardiograma de repouso e teste cardiopulmonar em três momentos diferentes: sem medicação, em uso de losartan, em uso de enalapril. Resultados: Foram estudados 7 (70 por cento homens e 3 (30 por cento) mulheres com idade entre 15 e 41 anos (média de 26 anos). A dose média diária de enalapril foi de 38mg com tempo médio de 3,9 meses e a de losartan foi de 90mg com tempo médio de três meses. Não houve efeitos adversos graves....

Angioedema por uso de inhibidores de la enzima convertidora de angiotensina en otorrinolaringología / Angioedema by users of inhibitors of the angiotensin converting enzyme in otorhynolaryngology

Se presenta una revisión de los casos de angioedema asociado al uso de Inhibidores de la Enzima Convertidora de Angiotensina de nuestro hospital. El objetivo es dar a conocer esta patología a la comunidad médica. La edad promedio de presentación fue de 67,8 años. Los pacientes tomaron el medicamento por entre 1 y 96 meses, antes de la aparición de los síntomas. La cantidad de episodios de angioedema antes del diagnóstico fue entre l y 7,el seguimiento después del tratamiento, entre 8 y 18 meses. El síntoma más frecuente fue edema lingual, aunque una paciente requirió tratamiento en la Unidad de Cuidados Intensivos con intubación orotraqueal. Se presenta una revisión de la literatura, con énfasis en la epidemiología, diagnóstico, mecanismo fisiopatológico y tratamiento de la enfermedad.

Efficacy and tolerability of trandolapril in mild to moderate hypertension--a double blind comparative clinical trial with enalapril in Indian population.

Several large scale clinical trials have demonstrated that angiotensin converting enzyme inhibitors offer cardiovascular and renal protection independent of their effects on systolic BP. Trandolapril is a new angiotensin converting enzyme inhibitor approved for the treatment of hypertension. The potential advantages of this drug are long duration of action and better tolerability. The objective of the study was to compare the efficacy and tolerability of trandolapril with that of enalapril in mild to moderate hypertension in Indian population. In this double blind, multicentric, parallel comparative clinical study, 120 patients with mild to moderate hypertension were randomly assigned to receive trandolapril 2 mg or enalapril 5 mg once daily for 8 weeks. The attainment of sitting diastolic blood pressure <90 mmHg at the end of 8th week was considered as primary outcome measure and attainment of diastolic blood pressure <90 mmHg or reduction of at least 10 mmHg diastolic blood pressure compared to baseline at any visit was considered as secondary outcome measures. 98.4% patients treated with trandolapril and 92.6% patients treated with enalapril fulfilled the primary outcome measure. 54, 72 and 62% patients on trandolapril and 52, 61 & 64% patients on enalapril fulfilled secondary outcome measure at the end of 2nd, 4th and 8th week respectively. Also trandolapril was better tolerated than enalapril with no significant abnormality in lab parameters.

effect of aspirin on angiotensin converting enzyme inhibitors-induced cough: a double blind clinical trial

Dry cough is the most common adverse effect and limiting factor of all angiotensin converting-enzyme inhibitors [ACEIs]. Prostaglandins have been pinpointed as playing an important role in the genesis of this problem. This double blind clinical trial desinged to study the efficacy of 500 milligram [mg] of aspirin comparing with placebo in controlling Enalapril-induced cough. The subjects were 32 patients who had developed Enalapril-induced cough.They were randomized into two groups: a group of daily dose of aspirin, 500 mg and a group of placebo for a treatment period of 4 weeks. Mean of cough severity was compared between two groups before treatment and weekly, until 4 weeks. Mean of cough severity in aspirin and placebo groups before and at the end of first week of treatment did not show any significant difference. After the second, third, and fourth weeks, cough severity scores were significantly reduced in aspirin group [p<0.001]. 500mg aspirin, once daily, can suppress or abolish Enalapril-induced cough and this finding proposes alternative therapeutic approach for ACEIs-induced related cough. Dry cough is the most common adverse effect and limiting factor of all angiotensin converting-enzyme inhibitors [ACEIs]. Prostaglandins have been pinpointed as playing an important role in the genesis of this problem. This double blind clinical trial desinged to study the efficacy of 500 milligram [mg] of aspirin comparing with placebo in controlling Enalapril-induced cough. The subjects were 32 patients who had developed Enalapril-induced cough.They were randomized into two groups: a group of daily dose of aspirin, 500 mg and a group of placebo for a treatment period of 4 weeks. Mean of cough severity was compared between two groups before treatment and weekly, until 4 weeks. Mean of cough severity in aspirin and placebo groups before and at the end of first week of treatment did not show any significant difference. After the second, third, and fourth weeks, cough severity scores were significantly reduced in aspirin group [p<0.001]. 500mg aspirin, once daily, can suppress or abolish Enalapril-induced cough and this finding proposes alternative therapeutic approach for ACEIs-induced related cough

Angiotensin converting enzyme inhibitor induced cough: experience in Siriraj Hospital.

With the increasing use of angiotensin converting enzyme inhibitors (ACEI) in the treatment of hypertension, particularly in diabetic patients, and heart failure, an annoying cough has frequently been observed. According to the post marketing surveillance studies, the prevalence of cough associated with ACEI was only 0.1-4 per cent. However, many recent studies have observed a very much higher frequency. To examine the incidence and pattern of cough associated with the usage of ACEI (C-ACEI) in a Thai population, mixed retrospective and prospective studies were performed in hypertensive patients who attended the out-patient department, Siriraj Hospital between December 1999 and August 2000. A thousand cases who had used or have been using ACEI were studied. C-ACEI was present in 179 cases of 760 retrospective studied cases (23.6%) and 75 cases of 240 prospective studied cases (31.3%). Cough was typically described as irritative (93.8% retrospectively and 98.7% prospectively, p = 0.05) and nocturnal in onset (74.9% retrospectively and 80% prospectively, p = 0.12), and usually appeared within the first 4 weeks of treatment (41.3% retrospectively and 46.7% prospectively, p = 0.43). Patients who received a full dosage of ACEI did not have to posses an increasing risk of C-ACEI. There was no difference in the prevalence of C-ACEI among types of ACEI, except cilazapril and quinapril which were found to be higher than enalapril in the retrospective study (p < 0.0001 and p = 0.002, respectively). Types of study were shown to influence the prevalence of C-ACEI. Prospective studies yielded a higher rate of C-ACEI than retrospective ones.

An unusual case of neonatal anuria.

Neonatal anuria is not an uncommon problem in neonates. Here, we report an unusual case of neonatal anuria due to renal tubular dysgenesis, secondary to the use of angiotensin converting enzyme inhibitor (ACEI) during pregnancy. ACEI remains one of the most commonly used antihypertensive drug at present. A greater awareness needs to be created in the medical fraternity especially among pediatricians, gynecologists and internists that ACE inhibitors should not be prescribed during any trimester of pregnancy.

Evaluation of efficacy and safety of losartan potassium in the treatment of mild to moderate hypertension as compared to enalapril maleate.

AIM: To study the effect of losartan potassium in the treatment of mild to moderate hypertension and to compare its efficacy and adverse effect profile with enalaparil maleate. MATERIAL AND METHODS: One hundred and forty five patients with mild to moderate essential hypertension were enrolled in this randomized, double blind, controlled, parallel and multicentric study. Seventy two patients received losartan potassium 50 mg and seventy three received enalapril maleate 5 mg. RESULTS: Losartan potassium reduced the DBP to < 90 mm Hg in 59% of the patients at the end of 8 weeks compared to 45% in the enalapril maleate group. DBP was reduced by 10 or > than 10 mm Hg in 89% of the patients with losartan as compared to the baseline whereas it was 80% in the enalapril group. Percentage of side effects seen in losartan and enalapril groups were 12 and 22 respectively. CONCLUSION: Losartan potassium is an efficacious antihypertensive agent in mild to moderate hypertension. It also has fewer side effects when compared to enalapril maleate.