Enalapril Maleate Tablet

The core mechanism of Enalapril Maleate Tablet, as an angiotensin-converting enzyme inhibitor (ACEI), is to inhibit ACE and block the conversion of angiotensin I to angiotensin II. Angiotensin II is one of the strongest vasoconstrictors in the body, and its reduced production can directly lead to peripheral vasodilation, lower peripheral vascular resistance, and thus lower blood pressure. In addition, ACE inhibition can reduce aldosterone secretion, promote water and sodium excretion, and further assist in lowering blood pressure.
Widely applicable: covering various types such as primary hypertension, renal vascular hypertension, malignant hypertension, etc. Among them, renal vascular hypertension is caused by renal artery stenosis leading to overactivation of the renin-angiotensin system (RAS), and Enalapril can exert specific antihypertensive effects by inhibiting the RAS system.

Dose flexibility: The initial dose is usually 5-10mg per day, divided into 1-2 oral doses. For patients with severe renal impairment (creatinine clearance rate<30ml/min), the initial dose should be reduced to 2.5mg/day to avoid adverse reactions such as hypotension caused by drug accumulation.
Advantages of combination therapy: When used in combination with diuretics (such as hydrochlorothiazide), it can significantly enhance the antihypertensive effect, especially for refractory hypertension. However, it is necessary to avoid the combination with pond potassium diuretics (such as spironolactone) to prevent hyperkalemia.

The position of Enalapril Maleate Tablet in the treatment of heart failure stems from its dual regulatory effect on the neuroendocrine system: on the one hand, it reduces the production of angiotensin II and aldosterone by inhibiting the RAS system, thereby alleviating cardiac afterload; On the other hand, by inhibiting the degradation of bradykinin and enhancing the release of nitric oxide (NO) and prostaglandins (PG), it exerts vasodilation and anti myocardial remodeling effects.
Symptomatic heart failure: used to improve survival rate, delay heart failure progression, and reduce hospitalization frequency. Research shows that Enalapril can reduce the mortality rate of heart failure patients by 27% and the hospitalization rate by 31%.

Asymptomatic left ventricular dysfunction: For asymptomatic patients with a left ventricular ejection fraction (LVEF) ≤ 35%, Enalapril can delay the onset of heart failure and reduce the risk of hospitalization.
Dose adjustment: The initial dose is usually 2.5mg twice a day, gradually increasing to the target dose (usually 10-20mg twice a day) based on tolerance. The maximum dose should not exceed 40mg/day.

Patients with renal insufficiency should pay special attention to dosage adjustment when using Enalapril, as the drug is mainly excreted through the kidneys. Reduced renal function can lead to drug accumulation, increasing the risk of adverse reactions such as hypotension and hyperkalemia.
Mild renal insufficiency (creatinine clearance rate 30-60ml/min): No need to adjust the initial dose, but close monitoring of blood pressure and renal function is required.

Moderate renal insufficiency (creatinine clearance rate<30ml/min): The initial dose is reduced to 2.5mg/day, and the maximum dose does not exceed 10mg/day.
Dialysis patients: Medication should be administered after dialysis to avoid blood pressure fluctuations caused by rapid drug clearance during the dialysis process.

Enalapril plays an important role in the secondary prevention of myocardial infarction by inhibiting the RAS system, reducing myocardial remodeling, and lowering the risk of recurrent infarction and death.
The American College of Cardiology (ACC)/American Heart Association (AHA) guidelines recommend that for patients with ST segment elevation myocardial infarction (STEMI) without contraindications, ACEI treatment should be initiated within 24 hours of onset.
The European Society of Cardiology (ESC) guidelines list ACEIs as Class I recommended drugs for long-term treatment after myocardial infarction.

Enalapril Maleate Tablet can reduce glomerular hypertension, hyperperfusion and hyperfiltration by inhibiting RAS system, thus delaying the progress of diabetes nephropathy.
The guidelines of the American diabetes Association (ADA) recommend that ACEI or ARB (angiotensin receptor antagonist) should be used for the treatment of type 1 and type 2 diabetes patients with microalbuminuria.
According to the guidelines of KDIGO, ACEI is listed as the first-line treatment drug for diabetes nephropathy.

Enalapril can also be used to treat certain types of cardiovascular diseases, such as aortic valve stenosis, hypertrophic cardiomyopathy, etc., but it needs to be used under the guidance of a specialist doctor.