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Their mechanisms are plausible because they can influence growth hormone and insulin-like growth factor-1 signalling

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PMID: 16226935 rxlist.com - hydralazine (Apresoline ) Keywords ACE-I Pharmacology Drugs: Captopril (generic, Capoten ), Enalapril - a prodrug - (Vasotec ) Pharmacological Effects: Decreased Ang II levels cause decreased peripheral resistance & decreased afterload Decreased aldosterone secretion leads to decreased salt & water retention & thereby decreased preload Decreased breakdown of bradykinin results in increased kinin activity & increased vasodilation Decreased Ang II reduces angiotensin-mediated norepinephrine release from sympathetic nerve terminals A net effect of these mechanisms is decreased BP No reflex tachycardia (unlike other vasodilators), making them safe to use in patients with ischemic heart disease Can slow or reverse certain parameters of cardiac remodeling that occur in CHF Side Effects: CAPTOPRIL mneumonic: ough (5-10% of patients, mostly women) - Bradykinin & Substance P induced C ngioedema (est 0.1 to 6.0% of patients) - Suspected Causes: Bradykinin, Complement or Autoantibodies A roteinuria P aste changes T rthostatic hypotension (or hypotension) O regnancy problems (fetal renal damage & mortality if taken during 2nd & 3rd trimester) P ash R ncreased renin & lower angiotensin II I ytes (for the electro-lyte disturbance of L due to decreased aldosterone secretion) hyperkalemia Pregnancy Risk: Risk Category C for risk during the 2nd & 3rd trimesters These drugs disrupt the fetal renin-angiotensin system, which is essential for normal renal development They can cause a prolonged fetal hypotension & hypoperfusion that results in renal ischemia, renal tubular dysgenesis & anuria They can also prevent normal lung development, growth retardation & limb shortening

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