Angiotensin-converting enzyme (ACE) inhibitors, are vasodilators that work by preventing the formation of angiotensin II. This substance is a powerful constrictor of arteries and also causes the retention of water and salt. ACE inhibitors also cause an increase in bradykinin, a vasodilator. The end result is that blood vessels relax and blood pressure drops, reducing the workload on the heart.
Advertisement
ACE inhibitors can improve blood flow to the kidneys, reduce protein (albumin) in the urine and prevent progression of kidney disease.
ACE inhibitors are safe and effective drugs for hypertension treatment. These drugs have also become less expensive.
A few ACE inhibitors
Captopril in Capoten.
Perindopril in Coversyl.
Enalapril in Renitec.
Ramipril in Tritace.
Lisinopril in Zestril, Zetomax.
Who may benefit from using ACE inhibitors?
These drugs are very helpful in treating patients with heart failure, especially if it was caused by hypertension. This includes patients with an enlarged or dysfunctional left ventricular wall, the main pumping chamber of the heart. It can therefore be helpful after a heart attack.
Diabetics, especially those on insulin, may clearly benefit from treatment with ACE inhibitors. These drugs have been shown to protect the kidneys, a vulnerable target organ in diabetic patients.
Compelling indications for use as anti-hypertensive drug
Diabetes, with or without nephropathy (kidney damage).
Heart failure.
Left ventricular dysfunction, especially after a heart attack.
How to take ACE inhibitors (dosage)
The first dose may give a sudden drop in blood pressure that could cause dizziness. ACE inhibitors are often introduced slowly and/or initially given at night.
ACE inhibitors are usually given once daily, which is very convenient. Do not stop the drug without consulting with your doctor.
Who should not take ACE inhibitors?
ACE inhibitors protect the kidneys of diabetics by slowing the progression of kidney failure. However, in patients with severe kidney failure these drugs may aggravate the condition and cause retention of potassium. However, under certain circumstance it may be beneficial in chronic renal failure, but is only used with caution, close supervision and specialist advice.
Patients using ACE inhibitors should not take potassium-sparing drugs like certain diuretics, or potassium supplementation.
ACE inhibitors must not be used during pregnancy or if planning to fall pregnant. It may cause birth defects and fetal death.
Compelling contraindications
Pregnancy.
Hyperkaleamia – high blood levels of potassium.
Bilateral renal artery stenosis – narrowing of the arteries that supply the kidneys, on both sides.
Angio-oedema.
Possible contraindications or limited value
Renal impairment – patients with kidney disease may retain potassium.
Peripheral vascular disease.
Limited value as monotherapy in African patients.
Inform your doctor if:
You might be pregnant or are planning a baby.
You have kidney or liver problems.
You have blood vessel disease.
You are taking any other medication.
You had side-effects with previous use of ACE inhibitors, especially angio-oedema.
Possible side-effects
The most common adverse effect is a dry cough. It is found in approximately 10 to 20% of patients taking ACE inhibitors, and may require the drug to be stopped.
Some patients develop a skin rash and others may experience a change in their sense of taste.
An acute allergic reaction, is a very rare but life-threatening side-effect.
Can it be taken with other drugs?
Non-steroidal anti-inflammatory drugs, like indometacin, may reduce the effect of ACE inhibitors.
Most of these drugs can increase the levels of lithium in the blood, and must be avoided in patients taking lithium.
If taken with potassium supplements or potassium-sparing drugs, the blood levels of this mineral may become dangerously high.
Bookmark with:
What are social bookmarks?