CASE – 09

A 72-year-old man presents to the office for routine follow-up. He is under treatment for hypertension and congestive heart failure with enalapril and a diuretic. His blood pressure is under acceptable control and he has no symp- toms of heart failure at present. He does complain that he has been coughing frequently in the past few months. History and examination reveal no other cause of a chronic cough, so you decide to discontinue his enalapril and start him on losartan.

1) What is the mechanism of action of enalapril?

2) By what mechanism does enalapril convert to its active form enalaprilat?

3) What is the likely cause of the cough?

4) What is the mechanism of action of losartan?

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