Figure 183

Agents that inhibit the renin-angiotensin-aldosterone system and points at which they act. CE, converting enzyme; Aase, aspartyl aminopeptidase.

concentrations are also thought to contribute to cough and angioedema sometimes seen after ACE inhibition.

The hypotensive response to captopril is accompanied by a fall in plasma aldosterone and angiotensin II levels and an increase in plasma renin activity. Serum potassium levels are not affected unless potassium supplements or potassium-sparing diuretics are used con-comitantly; this can result in severe hyperkalemia.

There is no baroreflex-associated increase in heart rate, cardiac output, or myocardial contractility in response to the decrease in pressure, presumably because capto-pril decreases the sensitivity of the baroreceptor reflex.

Captopril enhances cardiac output in patients with congestive heart failure by inducing a reduction in ventricular afterload and preload. Converting enzyme inhibitors have been shown to decrease the mass and wall

Angiotensin I

Bradykinin

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