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ACE Inhibitors

Introduction

ACE inhibitors (angiotensin converting enzyme inhibitors) e.g. ramipril, perindopril, enalapril, lisinopril, captopril are commonly used medications to treat hypertension and heart failure – they are considered first line agents in both of these important conditions. Through multiple mechanisms they act to both reduce the blood volume, and cause vasodilation, therefore decreasing peripheral vascular resistance.

About 10% of patients will get a dry cough as a result of an accumulation of bradykinin in the lungs. These patients should be switch to an angiotensin-II receptor blocker instead. They also carry a small risk of renal failure and hyperkalaemia.

They are also commonly referred to as ‘reno-protective’ – meaning that in the early stages of renal failure – particularly that associated with proteinuria (especially in T2DM) they can prevent the advancement of renal disease.

Mechanism

ACE inhibitors competitively inhibit the angiotensin converting enzyme (ACE), and thus reduce the generation of angiotensin-II, and also consequently aldosterone. This reduces sodium and water retention.
Renin-angiotension-aldosterone system indicating the mechanism of action of ACE inhibitors

Pharmakokinetics

Indications

Cautions

Unwanted effects

References

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