Angiotensin-converting enzyme inhibitor
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."
Angiotensin-converting enzyme inhibitors also decrease the degradation of bradykinin as the enzyme kininase II is the same enzyme as angiotensin-converting enzyme. This may contribute to some patients having a cough when taking angiotensin-converting enzyme inhibitors.
In hypertension, all ACE inhibitors have a similar degree of lowering the blood pressure.. At half of the maximum dose, the average reduction in blood pressure is -8/-5 mm Hg.
Chronic kidney disease
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".
Angiotensin-converting enzyme inhibitors may cause angioedema, which may be located in the bowel.
This may be more severe with angiotensin-converting enzyme inhibitors that have a longer half life such as enalapril.
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