- ACE inhibitors work by causing the kidneys to reduce the secretion of a substance called ACE, ultimately causing relaxation and widening of the blood vessel walls and reduction in blood pressure.
- ACE inhibitors are prescribed as the first-line treatment of hypertension, especially in patients with heart disorders such as heart failure, both ST elevation, and non-ST elevation myocardial infarction, and in patients with chronic kidney disease with proteinuria (an abnormal condition in which high protein levels are seen in the urine).
Although ACE inhibitors are considered the first line of treatment for hypertension, they may be given in combination with other groups of antihypertensive agents such as diuretics, calcium channel blockers, angiotensin II receptor blockers, or direct renin inhibitors.
Random clinical trials done on participants show that no ACE inhibitor medicine appears to be better or worse than others in terms of blood pressure-reducing ability. However, several other studies conducted on ACE inhibitors reported that:
- Trandolapril is more successful in lowering both systolic and diastolic blood pressure.
- Enalapril effectively reduces blood pressure because it simultaneously improves heart function. However, it is associated with side effects such as increased cough, gastrointestinal discomfort, and impairment of kidney function in higher doses.
- Ramipril was linked to the lowest risk of death from any cause.
- Lisinopril was the least effective in blood pressure control and is associated with a high risk of death. However, it was effective in reducing albumin excretion in the urine in patients with diabetes.
- The U.S. Food and Drug Administration approved captopril for diabetic nephropathy.
What are the examples of ACE inhibitors?
Drugs that come under the group angiotensin-converting enzyme (ACE) inhibitors include:
Except for captopril and lisinopril, all other drugs are prodrugs.
Prodrugs are drugs in their inactive form that have to be converted into their active forms in the body. This activation of prodrugs takes place in the liver. This implies that patients with liver anomalies are given active drugs such as captopril and lisinopril for the management of hypertension.
Some ACE inhibitors are metabolized by the liver and a few by the kidneys. Therefore, ACE inhibitors given may vary from patient to patient and are given according to their health conditions.
How do ACE inhibitors work?
As the name suggests, angiotensin-converting enzyme (ACE) inhibitors inhibit an enzyme named ACE and interfere with the renin-angiotensin–aldosterone system (RAAS), which plays a major role in maintaining blood pressure in the body.
- ACE converts the hormone angiotensin I to its active form—angiotensin II—in the body.
- Hormone angiotensin II acts on the blood vessels and causes narrowing of the vessels (vasoconstriction).
- Narrowing of the blood vessels caused by angiotensin II increases blood pressure.
- Moreover, angiotensin II stimulates the release of another hormone—aldosterone.
- Aldosterone is an antidiuretic hormone that increases the reabsorption of water and salt by the kidney. This increases in blood volume and eventually increases blood pressure.
ACE inhibitors prevent the conversion of angiotensin I to angiotensin II, increasing the elimination of excess water and salt through the urine. With decreased blood volume, the cardiac output and stroke volume decrease, resistance in the renal blood vessels reduce, and venous capacity increases.
Bradykinin is another chemical that causes the blood vessels to widen (vasodilation). ACE participates in the breakdown of bradykinin. ACE inhibitors prevent the breakdown of bradykinin that resulting in high bradykinin levels, leading to dilation of the blood vessels.
What are the uses of ACE inhibitors?
Apart from hypertension, angiotensin-converting enzyme inhibitors have been indicated to prevent, treat, or improve symptoms of various conditions, such as:
What are the side effects of ACE inhibitors?
Angiotensin converting enzyme (ACE) inhibitors are usually considered safe when taken in recommended doses. However, there are some side effects associated with them, which include:
- Dry cough, which may become chronic and last up to a month
- Hyperkalemia (high serum potassium levels)
- Decrease in blood pressure
- Changes in taste
- Loss of taste or dry mouth
- Metallic or salty taste
- Chest pain
- Increased serum uric acid levels
- Increased blood urea nitrogen and creatinine levels
- Sensitivity to sun
- Blurred vision
A few serious side effects associated with ACE inhibitors may include:
- Kidney failure
- Life-threatening allergic reactions
- Angioedema (swelling) of the neck, head, or intestines
- angioedema in the tongue and throat may be life-threatening
- Risk of fetal developmental abnormalities or miscarriage as seen in pregnant women who are on ACE inhibitors
- do not take these drugs or discontinue them during pregnancy
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ACE inhibitors for the treatment of high blood pressure: https://www.cochrane.org/CD003823/HTN_ace-inhibitors-for-the-treatment-of-high-blood-pressure
Pharmacologic Management of Hypertension in Patients with Diabetes: https://www.aafp.org/afp/2008/1201/p1277.html
Comparison of the Efficacy and Safety of Different ACE Inhibitors in Patients With Chronic Heart Failure: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4753869/#:~:text=CONCLUSION-,When%20considering%20factors%20such%20as%20increased%20ejection%20fraction%2C%20stroke%20volume,the%20most%20effective%20ACE%20inhibitor.
Top Which ACE Inhibitor Is the Best for Hypertension Related Articles
ACE Inhibitors (Side Effects, List of Names, Uses, and Dosage)ACE inhibitors, or angiotensin (generic name) converting enzyme inhibitors, is a class of drugs that interact with blood enzymes to enlarge or dilate blood vessels and reduce blood pressure. These drugs are used to control high blood pressure (hypertension), treat heart problems, kidney disease in people with diabetes high blood pressure. These drugs also improve the survival rate of people who have survived heart attacks and they prevent early death of people from heart attacks, high blood pressure, and heart failure. Sometimes ACE inhibitors are combined with other drugs for treating a condition.
Examples of ACE inhibitors include benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), and ramipril (Altace). Examples of the most common side effects of this class of drugs are dizziness, headache, cough, rash, chest pain, and rash. There are serious side effects of this drug like kidney failure, severe allergic reactions, and liver dysfunction, or failure. ACE inhibitors all are similar in the way they work; however, they differ in how the body eliminates doses of the drug. Drug interactions, dosage, and pregnancy and safety information should be reviewed prior to taking this medication.
ACE Inhibitors vs. ARBsACE inhibitors (angiotensin converting enzyme inhibitors) and ARBs (angiotensin-receptor blockers) are used to treat high blood pressure (hypertension) and congestive heart failure, to prevent kidney failure in patients with high blood pressure or diabetes, and to reduce the risk of stroke. Learn more about drugs for the side effects and drug interactions.
ACE Inhibitors vs. Beta BlockersACE inhibitors (angiotensin converting enzyme inhibitors) and beta-blockers are used to treat high blood pressure (hypertension) and congestive heart failure, to prevent kidney failure in patients with high blood pressure or diabetes, and to reduce the risk of stroke. Learn more about the side effects and drug interaction for these drug classes.
Beta Blockers vs. Calcium Channel BlockersBeta blockers and calcium channel blockers are medications used to treat high blood pressure, angina (chest pain), and abnormal heart rhythms, and to prevent migraine headaches. Beta blockers and calcium channel blockers (CCBs) both dilate the blood vessels through different mechanisms, reducing pressure within and making it easier for the heart to pump blood.
Calcium Channel Blockers vs. ACE InhibitorsCalcium channel blockers (CCBs) and angiotensin-converting enzyme (ACE) inhibitors are used to treat high blood pressure. Calcium channel blockers (CCBs) are also used to relieve or prevent angina (chest pain), to treat certain abnormal heart rhythms, and to treat migraine headaches. ACE inhibitors are also used to treat left ventricular dysfunction and heart failure, to prevent strokes, and to prevent and treat kidney disease in people with hypertension or diabetes.
High Blood Pressure (Hypertension)
High blood pressure (hypertension) is a disease in which pressure within the arteries of the body is elevated. About 75 million people in the US have hypertension (1 in 3 adults), and only half of them are able to manage it. Many people do not know that they have high blood pressure because it often has no has no warning signs or symptoms.
Systolic and diastolic are the two readings in which blood pressure is measured. The American College of Cardiology released new guidelines for high blood pressure in 2017. The guidelines now state that blood normal blood pressure is 120/80 mmHg. If either one of those numbers is higher, you have high blood pressure.
The American Academy of Cardiology defines high blood pressure slightly differently. The AAC considers 130/80 mm Hg. or greater (either number) stage 1 hypertension. Stage 2 hypertension is considered 140/90 mm Hg. or greater.
If you have high blood pressure you are at risk of developing life threatening diseases like stroke and heart attack.
REFERENCE: CDC. High Blood Pressure. Updated: Nov 13, 2017.
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