Adverse reactions with XXXX ( @entity1289 ) inhibitors.

@entity1 @entity4688 @entity712 @entity1369 @entity1289 @entity101 @entity8 @entity2178 @entity7710 @entity3371 @entity177 @entity1413
Teprotide, a nonapeptide isolated from the venom of a Brazilian pit viper, Bothrops jararaca, was the first @entity1289 ( @entity1289 ) inhibitor to be discovered and tested. It was found to be an effective, non-toxic antihypertensive agent as well as an afterload-reducing agent for @entity1 with @entity712 ( @entity712 ). The primary activity of @entity7710 resulted from blockade of the angiotensin I converting enzyme--the pivotal step in the renin-angiotensin- @entity1369 system (RAAS), and consequent reductions in @entity2178 levels. There was limited clinical testing for teprotide because of: its scarcity; the need for parenteral administration; and the subsequent discovery and synthesis of @entity3371 , the first orally active @entity1289 inhibitor. @entity3371 is the prototype oral @entity1289 inhibitor and has been extensively studied since the initiation of formal studies in 1976. Perhaps one of the most closely researched drugs in modern times, the experience with @entity3371 now includes more than 12,000 @entity1 studied in formalized trials and over 4,000,000 @entity1 treated world-wide by physicians for @entity101 and @entity712 . Enalapril ( @entity4688 ) is the first of what appears to be a growing number of analogues which are structurally and pharmacodynamically different from @entity3371 ; yet, they possess the same capacity for inhibiting the activity of @entity1289 . The side effect profile of @entity4688 (and presumably future) @entity1289 inhibitors appears to be similar to @entity3371 , though clearly more experience is needed with newer agents. The initial use of @entity3371 was troubled by a relatively high incidence of side effects which will form the focus of this discussion. Partially the result of incomplete pharmacokinetic information, @entity3371 was administered in early studies at dosages now recognised to be far in excess of those necessary for drug action. In addition, dosages were given without regard for @entity177 , now known to be the main excretory route of @entity3371 . The population of those @entity1 studied frequently had chronic, treatment-resistant @entity101 , often associated with concomitant end-organ disease (especially @entity8 ); and many additional factors further complicating the clinical setting, e.g. a relatively high incidence of @entity1413 and immunosuppressive treatments.(ABSTRACT TRUNCATED AT 400 WORDS)
