Angiotensin-converting enzyme inhibitor

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Angiotensin-converting enzyme inhibitors (commonly ACE inhibitors) are a "class of drugs whose main indications are the treatment of hypertension and heart failure. They exert their hemodynamic effect mainly by inhibiting the renin-angiotensin system. They also modulate sympathetic nervous system activity and increase prostaglandin synthesis. They cause mainly vasodilation and mild natriuresis without affecting heart rate and contractility."[1]

Angiotensin-converting enzyme inhibitors also decrease the degradation of bradykinin as the enzyme kininase II is the same enzyme as angiotensin-converting enzyme.[2] This may contribute to some patients having a cough when taking angiotensin-converting enzyme inhibitors.

Examples

Enalapril should be prescribed twice daily.[3]

Uses

Hypertension

For more information, see: Hypertension.

In hypertension, all ACE inhibitors have a similar degree of lowering the blood pressure.[4]. At half of the maximum dose, the average reduction in blood pressure is -8/-5 mm Hg.

Heart failure

For more information, see: Heart failure.

Angiotensin-converting enzyme inhibitor can reduce morbidity from heart failure.[5]

Chronic kidney disease

For more information, see: Chronic kidney disease.


Vascular disease

For more information, see: Vascular disease.


Adverse effects

Cough

According to a clinical prediction rule, cough due to angiotensin-converting enzyme inhibitors is more likely among patients who are "older age, female gender, non-African American (with East Asian having highest risk), no history of previous angiotensin-converting enzyme inhibitor use, and history of cough due to another angiotensin-converting enzyme inhibitor".[6]

Angioedema

Angiotensin-converting enzyme inhibitors may cause angioedema, which may be located in the bowel.[7]

Hypotension

This may be more severe with angiotensin-converting enzyme inhibitors that have a longer half life such as enalapril.[8]

References

  1. Anonymous (2015), Angiotensin-converting enzyme inhibitors (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. Gainer JV, Morrow JD, Loveland A, King DJ, Brown NJ (October 1998). "Effect of bradykinin-receptor blockade on the response to angiotensin-converting-enzyme inhibitor in normotensive and hypertensive subjects". N. Engl. J. Med. 339 (18): 1285–92. PMID 9791144[e]
  3. Girvin B, McDermott BJ, Johnston GD (1999). "A comparison of enalapril 20 mg once daily versus 10 mg twice daily in terms of blood pressure lowering and patient compliance.". J Hypertens 17 (11): 1627-31. PMID 10608477[e]
  4. Heran BS, Wong MM, Heran IK, Wright JM (2008). "Blood pressure lowering efficacy of angiotensin converting enzyme (ACE) inhibitors for primary hypertension". Cochrane database of systematic reviews (Online) (4): CD003823. DOI:10.1002/14651858.CD003823.pub2. PMID 18843651. Research Blogging.
  5. Garg R, Yusuf S (May 1995). "Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. Collaborative Group on ACE Inhibitor Trials". JAMA 273 (18): 1450–6. PMID 7654275[e]
  6. Morimoto T, Gandhi TK, Fiskio JM, et al (June 2004). "Development and validation of a clinical prediction rule for angiotensin-converting enzyme inhibitor-induced cough". J Gen Intern Med 19 (6): 684–91. DOI:10.1111/j.1525-1497.2004.30016.x. PMID 15209608. PMC 1492376. Research Blogging.
  7. Scheirey CD, Scholz FJ, Shortsleeve MJ, Katz DS (2011). "Angiotensin-converting enzyme inhibitor-induced small-bowel angioedema: clinical and imaging findings in 20 patients.". AJR Am J Roentgenol 197 (2): 393-8. DOI:10.2214/AJR.10.4451. PMID 21785085. Research Blogging.
  8. Packer M, Lee WH, Yushak M, Medina N (October 1986). "Comparison of captopril and enalapril in patients with severe chronic heart failure". N. Engl. J. Med. 315 (14): 847–53. PMID 3018566[e]