Cardiovascular disease enalapril

A 72-year-old man with diabetes mellitus and cardiovascular disease developed major depression. He was taking aspirin (100 mg/day), enalapril (20 mg/day), and glibenclamide (5 mg/day). His serum sodium was 133 mmol/1 (reference range 134—146 mmol/1). He started to take reboxetine (4 mg/day) and after 8 days experienced malaise and nausea, at which time his serum sodium had fallen to 118 mmol/1. The reboxetine was withdrawn, and both his symptoms and the low serum sodium remitted over the next 6 days. Rechallenge with reboxetine produced a recurrence of both the low sodium and the accompanying symptoms. 

In addition to their benefits in patients with established heart failure, ACE inhibitors also are effective for prevention of heart failure. The SOLVD prevention trial showed that enalapril decreased the risk of hospitalization for worsening heart failure and reduced the composite end point of death and heart failure hospitalization in patients with asymptomatic left ventricular dysfunction. The development of diabetes mellitus, an important risk factor for cardiovascular disease that also increases morbidity and mortality in heart failure patients, is reduced by enalapril in patients with chronic heart failure. In a post-hoc analysis of the Heart Outcomes Prevention Evaluation (HOPE) trial, ramipril reduced the development of new-onset heart failure by nearly 25% in patients with normal EFs and no symptoms of heart failure. ... 

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