ACE inhibitor
Medication class for hypertension and kidney disease.
ACE inhibitors are a class of medication used primarily for the treatment of cardiovascular and kidney diseases. They work by causing relaxation of blood vessels and a decrease in blood volume, leading to lower blood pressure and decreased oxygen demand from the heart. They inhibit the activity of angiotensin-converting enzyme, decreasing formation of angiotensin II (a vasoconstrictor) and increasing bradykinin (a vasodilator).
- field
- Cardiovascular and kidney disease treatment
- known_for
- Lowering blood pressure by inhibiting angiotensin-converting enzyme
- common_examples
- benazepril, zofenopril, perindopril, trandolapril, captopril, enalapril, lisinopril, ramipril
- pregnancy_category
- ADEC pregnancy category D; boxed warning for second and third trimester
- common_side_effects
- cough, angioedema, hyperkalemia, kidney impairment
Lore & Background
ACE inhibitors were initially approved for the treatment of hypertension and can be used alone or in combination with other anti-hypertensive medications. Later, they were found useful for other conditions including acute myocardial infarction, heart failure, and kidney complications of diabetes mellitus. All ACE inhibitors but enalapril, which can be given intravenously, are administered orally. Most can be dosed once daily with the exception of captopril.
Reader's Guide
ACE inhibitors are a cornerstone in the management of hypertension and related cardiovascular and kidney diseases. Their significance lies in their dual mechanism: reducing angiotensin II and increasing bradykinin, which synergistically lowers blood pressure. They are a first-line initial drug choice for high blood pressure, though age, frailty, and race can influence treatment choices. However, they are contraindicated in pregnancy and in patients with previous angioedema from ACE inhibitor therapy, bilateral renal artery stenosis, or hypersensitivity. Their use requires careful monitoring of potassium and creatinine, especially in the elderly or those with dehydration. Dual RAAS inhibitor therapy with ACE inhibitors and ARBs significantly increases risk of kidney damage and hyperkalemia.
Did You Know?
- ACE inhibitors decrease formation of angiotensin II, a vasoconstrictor, and increase bradykinin, a vasodilator.
- The two most common side effects are angioedema and cough, explained by increased bradykinin levels.
- ACE inhibitors are ADEC pregnancy category D and have a boxed warning for birth defects when taken during the second and third trimester.
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