Angiotensin-converting enzyme inhibitor

From Citizendium, the Citizens' Compendium

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.

Contents 1 Uses 1.1 Hypertension 1.2 Heart failure 1.3 Chronic kidney disease 2 Adverse effects 2.1 Cough 3 References

Uses

Hypertension

For more information, see: Hypertension.

In hypertension, all ACE inhibitors have a similar degree of lowering the blood pressure.^[3]. 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.

Chronic kidney disease

For more information, see: Chronic kidney 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".^[4]

References

1. ↑ Anonymous, (2008) 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.
3. ↑ 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.
4. ↑ 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.