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."[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]
Hypotension
This may be more severe with angiotensin-converting enzyme inhibitors that have a longer half life such as enalapril.[5][6]
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.
- ↑ Vítovec J, Spinar J (September 2000). "First-dose hypotension after angiotensin-converting enzyme (ACE) inhibitors in chronic heart failure: a comparison of enalapril and perindopril. Slovak Investigator Group". Eur. J. Heart Fail. 2 (3): 299–304. PMID 10938492. [e]
- ↑ 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]