Enalapril 에 의한 기침 발생율

노승익(Seung Ik Roh),김명선(Myeong Seon Kim),김은실(Eun Sil Kim),서두선(Du Seon Seo),정내인(Nae In Jeong),이명숙(Myeong Suk Lee),한승수(Seung Soo Han),김광희(Kwang Hoi Kim),김윤권(Yoon Kweon Kim) 대한내과학회 1994 대한내과학회지 Vol.47 No.1

N/A Background: Enalapril is an angiotensin-converting enzyme inhibitor that has been widely used in treating hypertension, congestive heart failure, DM and various renal diseases. Cough has been recognized as a side effect of angiotensin-converting enzyme inhibitors. Therefore we studied the incidence and the chracteritics of Enalapril induced cough in Korea. Method: The sixty eight patients with Enalapril who visited out-patients department of internal medicine, Han-Il General Hospital during the period from april 1992 to october 1992 were included in this study. In all patients careful history taking and review of chart was done. Patients with respiratory disease were excluded. The criteria of angiotensin converting enzyme inhibitor induced cough was that cough developed after administration of Enalapril and improved after discontinuing drug and readministration of drug induce resume of symptom. Resnlts: Subjects include 34 males, 34 females and their average age was 53.3 years, Diseases of theirs were hypertension (57 cases}, congestive heart failure (5 eases), various renal disease (28 cases) and 9 patients of them were smokers. Average drug dosage was 11.7 mg a day and average administration duration was 182 days. Of the 68 patients, 23 patients (33.8%) had chronic cough due to enalapril, which had 12 male and 11 female patients. The cough disappearing time after withdrawal of the angiotensin-converting enzyme inhibitors was average 7.8 days. In 16 patients (two thirds of them), cough disappeared within 4 days after drug withdrawal. 9 patients had to stop taking drug because of severe cough. Generally the characters of cough induced by angiotensin-converting enzyme inhibitors were dry, persistent, tickling and tended to develope especially at night, Conclusion: Cough is not uncommon side effect in angiotensin-converting enzyme inhibitor users. There fore clinician should consider angiotensin-converting enzyme inhibitor induced cough initially when cough developed after angiotensin-converting enzyme inhibitor administration.

Angiotensin-Converting Enzyme Inhibitor(ACE Inhibitor)에 의해 유발된 안면부 맥관부종(angioedema) 치험례

하유군,정기용,백종우,김동우,박종형,전찬용,최유경,Hsia, Yu-Chun,Jung, Ki-Yong,Baik, Jong-Woo,Kim, Dong-Woo,Park, Jong-Hyung,Jun, Chan-Yong,Choi, You-Kyung 대한한방내과학회 2007 大韓韓方內科學會誌 Vol.28 No.2

Angioedema is a localized transient swelling of sudden onset that can occur in the face, lips, tongue, hand, feet, respiratory system and gastrointestinal system. Angioedema is classified as allergy, hereditary, idiopathic or induced by medication as like aspirin, nonsteroidal anti-inflammatory agents, opiates, antibiotics, and angiotensin-converting enzyme. Angiotensin-converting enzyme inhibitors are widely prescribed for hypertension and heart failure. This drug is commonly associated with angioedema which may be potentially life threatening. We experienced a case of angioedema induced by ACE inhibitor (angiotensin-converting enzyme inhibitor) in a 74-year-old patient who took ACE inhibitor to control hypertension during hospitalization. We thought the angioedema in the face had relation to myenzhong (面腫, mienjong) in oriental medicine. Weiling-tang (Wiryung-tang) was effective for angioedema in the face. As a result the symptoms disappeared rapidly. After 6 days, the patient's symptoms had notably improved.

Effect of angiotensin converting enzyme inhibitor and angiotensin II receptor blocker on the patients with sepsis

( Hyun Woo Lee ),( Jae Kyung Suh ),( Eunjin Jang ),( Sang-min Lee ) 대한내과학회 2021 The Korean Journal of Internal Medicine Vol.36 No.2

Background/Aims: Inhibitors of the renin-angiotensin system, angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs), reportedly have anti-inflammatory effects. This study assessed the association of prior use of ACE inhibitors and ARBs with sepsis-related clinical outcomes. Methods: A population-based observational study was conducted using the Health Insurance Review and Assessment Service claims data. Among the adult patients hospitalized with new onset of sepsis in 2012, patients who took ARBs or ACE inhibitors at least 30 days prior to hospitalization were analyzed. Generalized linear models and logistic regression were used to examine the relation between the prior use of medication and clinical outcomes, such as in-hospital mortality, mechanical ventilation, and length of stay. Results: Of a total of 27,628 patients who were hospitalized for sepsis, the ACE inhibitor, ARB, and non-user groups included 1,214 (4.4%), 3,951 (14.4%), and 22,463 (82.1%) patients, respectively. As the patients in the ACE inhibitor and ARB groups had several comorbid conditions, higher rates of intensive care unit admission, hemodialysis, and mechanical ventilation were observed. However, after covariate adjustment, the use of ACE inhibitor (odds ratio [OR], 0.752; 95% confidence interval [CI], 0.661 to 0.855) or ARB (OR, 0.575; 95% CI, 0.532 to 0.621) was significantly associated with a lower rate of in-hospital mortality. Conclusions: Pre-hospitalization use of ACE inhibitors or ARBs for sepsis was an independent factor for a lower rate of in-hospital mortality.

토끼의 난소 과자극증후군 유발에 미치는 내인성 Angiotensin 2의 작용 및 Angiotensin-converting Enzyme Inhibitor의 치료효과

박원일 ( Won Il Park ),송찬호 ( Chan Ho Song ),김병길 ( Pyung Kil Kim ),조동제 ( Dong Je Cho ),박기현 ( Ki Hyun Park ),장병철 ( Byung Chul Chang ) 대한산부인과학회 1997 Obstetrics & Gynecology Science Vol.40 No.12

Ovarian hyperstimulation syndrome is most serious complication during ovulation induction. Although the incidence of this disease is increasing, the pathophysiology remains uncertain. Consensus is that main pathophysiology of the disease is increased vascular permeability, but the etiologic agent causing hyperpermeability is still unknown, Prostaglandin, histamine, angiotensin, some cytokines and growth factors have been suspected as etiologic agent. At present, angiotensin is mostly suspected agent of this disease. The purpose of this study is revealing etiologic role of angiotensin II in ovarian hyperstimulation and assessing the therapeutic or preventive effect of lowering angiotensin II by angiotensin converting enzyme inhibitor. After developing of ovarian hyperstimulation in rabbit, Captopril were administerd in study group. The correlations between angiotensin II and clinical parameters of severity of the disease such as ovarian volume, amount of ascites or changes of hematocrit were assessed. The correlations between angiotensin II and prostaglandin or estradiol were also assessed. The Microfil was perfused through the ovarian arteries and morphology of vascularities were revealed. The differences in ovarian volume, amount of ascites, changes of hematocrit, prostaglandin and estradiol were checked between study and control group. The parameters of severity of ovarian hyperstimulation were closely related with the level of angiotensin II. The levels of prostaglandin and estradiol were also positively correlated with the level of angiotensin II. The degree of neovascularization tended to be increased in control group, but the individual variations were existed. The parameters of severity of ovarian hyperstimulation were markedly improved in captopril group. From this data, we can conclude that angiotensin II is related with development of ovarian hyperstimulation syndrome and angiotensin converting enzyme inhibitor can prevent the development of this disease.

안지오텐신 전환효소 억제제와 안지오텐신 수용체 대항제를 복용 중인 환자에서 수술 중 발생한 불응성 저혈압 —증례보고—

김은성,권오경,노희천,김정은 대한마취통증의학회 2008 Korean Journal of Anesthesiology Vol.53 No.3

Chronic treatment with renin-angiotensin system antagonists frequently causes deleterious hypotension during anesthesia. We present a case of marked intra-operative refractory hypotension in a 61-year-old male patient undergoing elective total thyroidectomy. He has been chronically treated for hypertension with angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists and atenolol, which were taken until the morning of surgery. After induction of anesthesia, marked hypotension which was refractory to fluid therapy occurred and did not respond to ephedrine administration. After continuous norepinephrine infusion, blood pressure increased and remained stable during the anesthesia period. Before extubation, norepinephrine was discontinued and recovery took place without complications. We discuss the anesthetic implication of chronic renin-angiotensin system antagonists treatment and intra-operative hemodynamic instability.

Angiotensin-Converting Enzyme Inhibitors and Angioedema

Mario Sanchez-Borges,Luis A Gonzalez-Aveledo 대한천식알레르기학회 2010 Allergy, Asthma & Immunology Research Vol.2 No.3

Purpose: To investigate the incidence and clinical characteristics of angioedema associated with the use of angiotensin-converting enzyme inhibitors (ACEIs) in an outpatient allergy department. Methods: A retrospective review of medical records of new patients seen in an allergy clinic. Demographic and clinical data of patients with ACEI-induced angioedema were analyzed. Results: Nine (0.37%) out of 2,421 new patients attending the allergy clinic developed ACEI-associated angioedema. Enalapril was the drug most frequently incriminated. The onset of the angioedema was as early as after the first dose or as late as 2 years after beginning treatment. Six patients experienced life-threatening angioedema involving the tongue, oropharynx, or larynx, and two patients required transfer to the intensive care unit. One patient required a tracheostomy. Conclusions: Angiotensin-converting enzyme inhibitor treatment is often responsible for angioedema, especially involving the upper airways. Due to the high proportion of the population exposed to ACEIs and to the severity of this adverse effect, it is important that physicians consider ACEIs as possible inducers when evaluating patients with acute or recurrent angioedema.

Tranexamic acid for angiotensin-converting enzyme inhibitor–induced angioedema

Pathak Gaurav Nitin,Truong Thu Minh,Chakraborty Abhishek,Rao Babar,Monteleone Catherine 대한응급의학회 2024 Clinical and Experimental Emergency Medicine Vol.11 No.1

Approximately 0.7% of patients taking angiotensin-converting enzyme inhibitors (ACEIs) develop ACEI-induced angioedema (ACEI-IA). With no approved treatments for ACEI-IA, the risk of complications is concerning. Tranexamic acid (TXA) has the potential to prevent intubations and resolve ACEI-IA by inhibiting the downstream production of bradykinin. In this review, we aim to evaluate the safety and efficacy of TXA use in ACEI-IA. We queried the PubMed database for studies involving TXA for ACEI-IA from January 2003 to January 2023. Seven studies met the study inclusion criteria. Our results demonstrate that TXA may improve angioedema symptoms and prevent intubation. In addition, its availability, low cost, and safety profile support its use for improving the symptoms and complications of ACEI-IA in an emergency setting.

Angiotensin-converting enzyme inhibitors versus angiotensin II receptor blockers in acute ST-segment elevation myocardial infarction patients with diabetes mellitus undergoing percutaneous coronary intervention

Choi, Se Yeon,Choi, Byoung Geol,Rha, Seung-Woon,Byun, Jae Kyeong,Shim, Min suk,Li, Hu,Mashaly, Ahmed,Choi, Cheol Ung,Park, Chang Gyu,Seo, Hong Seog,Oh, Dong Joo,Jeong, Myung Ho Elsevier 2017 INTERNATIONAL JOURNAL OF CARDIOLOGY Vol.249 No.-

<P><B>Abstract</B></P> <P><B>Background</B></P> <P>Diabetes Mellitus (DM) is an important factor of adverse cardiovascular events in acute ST-segment elevation myocardial infarction (STEMI) patients. Renin-angiotensin-aldosterone system (RAAS) inhibitors is associated with improved clinical outcomes, however, there are limited data comparing the effectiveness of two different RAAS inhibitors in STEMI patients with DM undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES).</P> <P><B>Methods</B></P> <P>A total of 3811 eligible STEMI patients with DM were enrolled in Korea Acute Myocardial Infarction Registry (KAMIR). They were stratified into two groups: Angiotensin converting enzyme inhibitors (ACEI) group (n=2691) and angiotensin receptor blockers (ARB) group (n=1120). To adjust baseline confounding factors, we performed propensity score matching (PSM) analysis and evaluated individual and composite major clinical outcomes between the two groups up to 2years.</P> <P><B>Results</B></P> <P>After PSM, a total of 1049 well-matched pairs were generated. Baseline clinical, angiographic and procedural characteristics were well-balanced between the two groups. The incidence of death, recurrent myocardial infarction (MI), revascularization and major adverse cardiac events (MACE) were not significantly different between the two groups up to 2years,</P> <P><B>Conclusion</B></P> <P>In the present study, ACEI and ARB showed comparable effectiveness and safety on individual and composite clinical outcomes in STEMI patients with DM who underwent successful PCI with DES at least up to 2years.</P>

Use of Renin-Angiotensin-Aldosterone System Inhibitors and Severe COVID-19 Outcomes in Patients with Hypertension: A Nationwide Cohort Study

배재현,최선규,김남훈,이준영,김신곤 대한당뇨병학회 2021 Diabetes and Metabolism Journal Vol.45 No.3

Background: Angiotensin-converting enzyme 2 facilitates the entry of severe acute respiratory syndrome coronavirus 2 into the human body. We investigated the association of renin-angiotensin-aldosterone system (RAAS) inhibitor use with severe coronavirus disease 2019 (COVID-19) outcomes in hypertensive patients. Methods: We identified hypertensive patients with confirmed COVID-19 from the Korean Health Insurance Review and Assessment Service from inception to May 15, 2020. The primary outcome was the composite of intensive care unit (ICU) admission, invasive mechanical ventilation (IMV), continuous renal replacement therapy (CRRT), extracorporeal membrane oxygenation (ECMO), and death from COVID-19. The individual components were evaluated as secondary outcomes. Results: Of 1,374 hypertensive patients with COVID-19, 1,076 (78.3%) and 298 (21.7%) were users and never-users of RAAS inhibitors, respectively. The RAAS inhibitor users were not associated with the risk of the primary outcome (adjusted odds ratio [aOR], 0.72; 95% confidence interval [CI], 0.46 to 1.10). The risk of ICU admission was significantly lower in the users than the never-users (aOR, 0.44; 95% CI, 0.24 to 0.84). The RAAS inhibitors were beneficial only in ICU admissions that did not require IMV (aOR, 0.28; 95% CI, 0.14 to 0.58). The risk of death from COVID-19 was comparable between the groups (aOR, 1.09; 95% CI, 0.64 to 1.85). We could not evaluate the risks of CRRT and ECMO owing to the small number of events. Conclusion: RAAS inhibitor use was not associated with the composite of severe outcomes in the hypertensive patients with COVID- 19 but significantly lowered the risk of ICU admission, particularly in patients who did not require IMV.

Comparison of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in patients with diabetes mellitus and non-ST-segment elevation myocardial infarction who underwent successful percutaneous coronary intervention

Byun, Jae Kyeong,Choi, Byoung Geol,Rha, Seung-Woon,Choi, Se Yeon,Jeong, Myung Ho Elsevier 2018 Atherosclerosis Vol.277 No.-

<P><B>Abstract</B></P> <P><B>Background and aims</B></P> <P>Angiotensin-converting-enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) are known to be beneficial for either non-ST-segment elevation myocardial infarction (NSTEMI) patients or diabetes mellitus (DM) patients. However, the comparative efficacy of ACEI <I>versus</I> ARB in patients with NSTEMI and DM is unclear. The aim of this study was to compare the protective efficacy of ACEI <I>versus</I> ARB in patients with NSTEMI and DM, who underwent percutaneous coronary intervention (PCI) with drug-eluting stents (DES).</P> <P><B>Methods</B></P> <P>Among 53,281 patients enrolled in the nationwide Korea Acute Myocardial Infarction Registry, 3426 patients with NSTEMI and DM, who were treated with renin-angiotensin system (RAS) inhibitors, had undergone successful PCI with DESs. They were classified into two groups: ACEI group (<I>N</I> = 2076), and ARB group (<I>N</I> = 1350). Individual major clinical outcomes and major adverse cardiac events (MACE), the composite of total death, myocardial infarction (MI), and revascularization were compared between the two groups for up to two years.</P> <P><B>Results</B></P> <P>After propensity score-matching analysis, two propensity-matched groups (1103 pairs, total = 2206) were generated, and the baseline characteristics were balanced. Although all causes of death and recurrent MI were not different between the two groups, the incidence of revascularization (4.0% <I>vs.</I> 7.1%; <I>p</I> = 0.002), including target vessel (2.3% <I>vs.</I> 5.0; <I>p</I> = 0.002), and MACE (8.7% <I>vs.</I> 12.5%, <I>p</I> = 0.008), were lower in the ACEI group than the ARB group at two-year follow-up.</P> <P><B>Conclusions</B></P> <P>Compared with ARB, no beneficial effects of ACEI on all causes of death, cardiac death, or recurrence of MI were observed, but ACEI reduced the incidence of revascularization and MACE in this population. Thus, well-designed trials with a larger population are needed to confirm these results.</P> <P><B>Highlights</B></P> <P> <UL> <LI> No beneficial effects of ACEI on total deaths, cardiac deaths, or recurrence of MI were observed. </LI> <LI> ACEI reduced the incidence of revascularization and MACE. </LI> <LI> In subgroup analysis, ACEI had a beneficial effect on MACE. </LI> </UL> </P>