Enalapril is a hypertensive drug used in the treatment of newly-diagnosed hypertension. It belongs to the class of angiotensin-converting enzyme inhibitors (ACEIs). Enalapril dilates veins and arteries by competitively impeding the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor (Faruqi & Jain, 2021). It also inhibits the metabolism of bradykinin, resulting in a decrease of preload and afterload in the heart. Enalapril further promotes sodium and water excretion by obstructing the secretion of aldosterone induced by angiotensin-II and brings forth renoprotective effects by vasodilating renal arterioles.
Patients on Enalapril should be monitored for vital signs, cardiac activity, and renal function. Potential side effects include dizziness, hypotension, headache, chest pain, nonproductive cough, and rash. The vasodilation caused by the drug in reducing the heart’s afterload and decreasing the total peripheral resistance causes hypotension (Faruqi & Jain, 2021). Enalapril should be stopped as soon as pregnancy is confirmed since it affects the renin-angiotensin system, causing oligohydramnios, which can cause fetal injury or death. Drug monitoring is needed when co-administering drugs that increase Enalapril’s hypotensive activity, such as loop diuretics, antipsychotics, Duloxetine, Levodopa, barbiturates, and thiazide diuretics (Faruqi & Jain, 2021). In addition, Enalapril should not be administered in drugs that diminish its antihypertensive effect, such as Amphetamines, Aprotinin, Bromperidol, Dexmethylphenidate, Lanthanum, and Methylphenidate.
Ethnic differences affect how patients with new-onset hypertension are treated since the lowering effects of most antihypertensive drugs differ among ethnic groups. For instance, people of African origin are generally less responsive to monotherapy with ACEIs, Beta-blockers, and angiotensin-receptor blockers (ARBs). They are more responsive to diuretics and calcium channel blockers. The ASH/ISH treatment guidelines recommend calcium channel blockers or thiazide diuretic as the first-line drug in patients of African ancestry without other major medical conditions (Unger et al., 2020). ARBs or ACEIs are the recommended first-line therapy for White and other non-African ancestries below 60 years. Consequently, treatment for African Americans can be modified to include a diuretic or calcium channel blocker in the initial treatment of hypertension.
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Faruqi, A., & Jain, A. (2021). Enalapril. In StatPearls. StatPearls Publishing.
Unger, T., Borghi, C., Charchar, F., Khan, N. A., Poulter, N. R., Prabhakaran, D., Ramirez, A., Schlaich, M., Stergiou, G. S., Tomaszewski, M., Wainford, R. D., Williams, B., & Schutte, A. E. (2020). 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension (Dallas, Tex. : 1979), 75(6), 1334–1357. https://doi.org/10.1161/HYPERTENSIONAHA.120.15026
Select a medication used for the treatment of newly diagnosed hypertension, chronic hypertension, or malignant hypertension, other than a diuretic. Share the mechanism of action of this medication and hints for monitoring, side effects, and drug interactions, including CAM, of which one should be aware. Discuss how ethnic, genetic, or cultural differences affect how you treat the patient and explain any adverse effects or drug interaction associated with the agents used to treat cardiovascular disease. Give examples of how you would modify your approach based on these factors. Include the name of the medication in the subject line so that the medications can be followed. Include references using APA format.