bradykinins

  Dear CCF CARDIO MD-MTR
   Is the build up of bradykinins while taking Zestril toxic?
  At what point coughing outway the benefit of Zestril vs. Cozaar?
  I seem to be doing better on Zestril except for the cough. Now my heart seems race at times and I have some swelling. Is there any solution to the build up of bradykinins in the future?
  Thank you for your response of march 26
  Sincerely Kim

[CCF Cardio MD-SGM]

_-
Dear Kim,
ACE inhibitors such as Zestril have been used for over a decade with excellent results.  Patients with high blood pressure as well as congestive heart failure benefit from this medication.  Thus, there is no demonstrated toxic effect of the bradykinins.   Side-effects such as cough are annoying, but are not related to any significant danger of taking ACE inhibitor medications.  In this setting, it is reasonable to substitute ACE inhibitors with A-II receptors antagonists such as Cozaar.  
To repeat what Dr. Roe described, standard practice in heart failure is to begin therapy with ACE inhibitors.  A-II antagonists are utilized only if patients do not tolerate the ACE inhibitors due to side effects.  Future research may show that A-II antagonists are equivalent to ACE inhibitors for heart failure management. However, this is not currently known to be true.   In deciding which one is better,  you must ask yourself how uncomfortable the cough was.  If this was a significant problem, then Cozaar is likely the better choice.  Don't worry about the bradykinins otherwise.  
Regarding the increased swelling, you might want to discuss with your doctor a possible increase in the diuretic (lasix) dose.   Finally, racing heartbeats may be an indication of a disturbance in the heart's rhythm.  This may warrant an extended recording of the ECG using a portable monitor known as a Holter, for 24-48 hours, in order to diagnose what is causing the palpitations.  This, as well, should be discussed with your doctor.
I hope this reply been helpful.  Information provided in the Heart Forum is for general purposes only.  Specific diagnoses and therapies should be sought only from your personal physician.