Angiotensin-converting enzyme inhibitor: Difference between revisions
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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.<ref>{{MeSH|Angiotensin-converting enzyme inhibitors}}</ref> | '''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."<ref>{{MeSH|Angiotensin-converting enzyme inhibitors}}</ref> | ||
Angiotensin-converting enzyme inhibitors also decrease the degradation of [[bradykinin]] as the enzyme kininase II is the same enzyme as [[angiotensin-converting enzyme]].<ref name="pmid9791144">{{cite journal |author=Gainer JV, Morrow JD, Loveland A, King DJ, Brown NJ |title=Effect of bradykinin-receptor blockade on the response to angiotensin-converting-enzyme inhibitor in normotensive and hypertensive subjects |journal=N. Engl. J. Med. |volume=339 |issue=18 |pages=1285–92 |year=1998 |month=October |pmid=9791144 |doi= |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=9791144&promo=ONFLNS19 |issn=}}</ref> This may contribute to some patients having a cough when taking angiotensin-converting enzyme inhibitors. | |||
==Uses== | |||
===Hypertension=== | |||
{{main|Hypertension}} | |||
In hypertension, all ACE inhibitors have a similar degree of lowering the blood pressure.<ref name="pmid18843651">{{cite journal |author=Heran BS, Wong MM, Heran IK, Wright JM |title=Blood pressure lowering efficacy of angiotensin converting enzyme (ACE) inhibitors for primary hypertension |journal=Cochrane database of systematic reviews (Online) |volume= |issue=4 |pages=CD003823 |year=2008 |pmid=18843651 |doi=10.1002/14651858.CD003823.pub2 |url=http://dx.doi.org/10.1002/14651858.CD003823.pub2 |issn=}}</ref>. At half of the maximum dose, the average reduction in blood pressure is -8/-5 mm Hg. | |||
===Heart failure=== | |||
{{main|Heart failure}} | |||
===Chronic kidney disease=== | |||
{{main|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".<ref name="pmid15209608">{{cite journal |author=Morimoto T, Gandhi TK, Fiskio JM, ''et al'' |title=Development and validation of a clinical prediction rule for angiotensin-converting enzyme inhibitor-induced cough |journal=J Gen Intern Med |volume=19 |issue=6 |pages=684–91 |year=2004 |month=June |pmid=15209608 |pmc=1492376 |doi=10.1111/j.1525-1497.2004.30016.x |url=http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=0884-8734&date=2004&volume=19&issue=6&spage=684 |issn=}}</ref> | |||
==References== | ==References== | ||
<references/> | <references/> | ||
Revision as of 07:48, 29 October 2008
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.
Uses
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
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
- ↑ Anonymous (2024), Angiotensin-converting enzyme inhibitors (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ 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]
- ↑ 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.
- ↑ 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.