ACEinhibitors

ACE inhibitors, also known as angiotensin-converting enzyme inhibitors, are a class of medications used primarily to treat hypertension and heart failure. They block the angiotensin-converting enzyme, reducing production of angiotensin II, a potent vasoconstrictor. The result is vasodilation and decreased secretion of aldosterone, which lowers blood pressure and reduces fluid retention. In addition, ACE inhibitors increase levels of bradykinin, which can contribute to a dry cough and, rarely, angioedema.

Commonly prescribed ACE inhibitors include enalapril, lisinopril, ramipril, captopril, benazepril, and perindopril. Some are available as prodrugs that are activated after absorption (for example, enalapril); others are active forms (lisinopril, captopril). They may be used to treat essential hypertension, heart failure with reduced ejection fraction, post-myocardial infarction, and chronic kidney disease, especially with diabetic nephropathy; they can also reduce proteinuria and slow the progression of kidney disease.

Contraindications include pregnancy and bilateral renal artery stenosis. Caution is advised in renal impairment, dehydration, and patients at risk of hyperkalemia. Potential adverse effects include hypotension, dizziness, cough, hyperkalemia, and, less commonly, angioedema, which is a medical emergency.

Monitoring involves baseline and follow-up measurements of blood pressure, kidney function (creatinine), and serum potassium after initiation or dose changes. ACE inhibitors are commonly avoided with some combinations of other agents in certain settings, such as with ARBs or aliskiren, and NSAIDs may reduce their antihypertensive effect.