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Ramipril is a pro-drug.The molecule must be hydrolyzed by an esterase at the OCH 2 CH 3 and form a carboxylate.This carboxylate then interacts with the positive Zn 2+ ion which is located at the active site of the ACE enzyme. [10]
A cerebral vasodilator is a drug which acts as a vasodilator in the brain. [1] [2] They are used to improve blood flow in people with cerebrovascular insufficiency and to treat neurological disorders secondary to this condition. [2] A number of different cerebral vasodilators exist.
Some believe ramipril's additional benefits may be shared by some or all drugs in the ACE-inhibitor class. However, ramipril currently remains the only ACE inhibitor for which such effects are actually evidence-based. [64] A meta-analysis confirmed that ACE inhibitors are effective and certainly the first-line choice in hypertension treatment.
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Chlorthalidone is the thiazide drug that is most strongly supported by the evidence as providing a mortality benefit; in the ALLHAT study, a chlorthalidone dose of 12.5 mg was used, with titration up to 25 mg for those subjects who did not achieve blood pressure control at 12.5 mg. Chlorthalidone has repeatedly been found to have a stronger ...
Arteriolar vasodilators are substances or medications that preferentially dilate arterioles. When used on people with certain heart conditions, it causes a phenomenon known as the cardiac steal syndrome. [citation needed] Arteriolar vasodilators increase intracapillary pressure, which causes fluid to enter the tissues, leading to vasodilatory ...
ACE is also part of the kinin–kallikrein system where it degrades bradykinin, a potent vasodilator, and other vasoactive peptides. [12] Kininase II is the same as angiotensin-converting enzyme. Thus, the same enzyme (ACE) that generates a vasoconstrictor (ANG II) also disposes of vasodilators (bradykinin). [11]
Hydralazine is not used as a primary drug for treating hypertension because it elicits a reflex sympathetic stimulation of the heart (the baroreceptor reflex). [9] The sympathetic stimulation may increase heart rate and cardiac output, and in people with coronary artery disease may cause angina pectoris or myocardial infarction. [10]