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'''Angiotensin-converting enzyme inhibitors''' (commonly '''ACE inhibitors''') are a "class of drugs whose main indications are the treatment of [[hypertension]] and [[heart failure]]. They exert their hemodynamic effect mainly by inhibiting the [[renin-angiotensin system]]. They also modulate sympathetic nervous system activity and increase prostaglandin synthesis. They cause mainly vasodilation and mild natriuresis without affecting heart rate and contractility.<ref>{{MeSH|Angiotensin-converting enzyme inhibitors}}</ref> | {{TOC|right}} | ||
'''Angiotensin-converting enzyme inhibitors''' (commonly '''ACE inhibitors''') are a "class of drugs whose main indications are the treatment of [[hypertension]] and [[heart failure]]. They exert their hemodynamic effect mainly by inhibiting the [[renin-angiotensin system]]. They also modulate sympathetic nervous system activity and increase prostaglandin synthesis. They cause mainly vasodilation and mild natriuresis without affecting heart rate and contractility."<ref>{{MeSH|Angiotensin-converting enzyme inhibitors}}</ref> | |||
Angiotensin-converting enzyme inhibitors also decrease the degradation of [[bradykinin]] as the enzyme kininase II is the same enzyme as [[angiotensin-converting enzyme]].<ref name="pmid9791144">{{cite journal |author=Gainer JV, Morrow JD, Loveland A, King DJ, Brown NJ |title=Effect of bradykinin-receptor blockade on the response to angiotensin-converting-enzyme inhibitor in normotensive and hypertensive subjects |journal=N. Engl. J. Med. |volume=339 |issue=18 |pages=1285–92 |year=1998 |month=October |pmid=9791144 |doi= |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=9791144&promo=ONFLNS19 |issn=}}</ref> This may contribute to some patients having a cough when taking angiotensin-converting enzyme inhibitors. According to a [[clinical prediction rule]], [[cough]] due to angiotensin-converting enzyme inhibitors is more likely among patients who are "older age, female gender, non-African American (with East Asian having highest risk), no history of previous angiotensin-converting enzyme inhibitor use, and history of cough due to another angiotensin-converting enzyme inhibitor".<ref name="pmid15209608">{{cite journal |author=Morimoto T, Gandhi TK, Fiskio JM, ''et al'' |title=Development and validation of a clinical prediction rule for angiotensin-converting enzyme inhibitor-induced cough |journal=J Gen Intern Med |volume=19 |issue=6 |pages=684–91 |year=2004 |month=June |pmid=15209608 |pmc=1492376 |doi=10.1111/j.1525-1497.2004.30016.x |url=http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=0884-8734&date=2004&volume=19&issue=6&spage=684 |issn=}}</ref> | Angiotensin-converting enzyme inhibitors also decrease the degradation of [[bradykinin]] as the enzyme kininase II is the same enzyme as [[angiotensin-converting enzyme]].<ref name="pmid9791144">{{cite journal |author=Gainer JV, Morrow JD, Loveland A, King DJ, Brown NJ |title=Effect of bradykinin-receptor blockade on the response to angiotensin-converting-enzyme inhibitor in normotensive and hypertensive subjects |journal=N. Engl. J. Med. |volume=339 |issue=18 |pages=1285–92 |year=1998 |month=October |pmid=9791144 |doi= |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=9791144&promo=ONFLNS19 |issn=}}</ref> This may contribute to some patients having a cough when taking angiotensin-converting enzyme inhibitors. | ||
==Examples== | |||
[[Enalapril]] should be prescribed twice daily.<ref name="pmid10608477">{{cite journal| author=Girvin B, McDermott BJ, Johnston GD| title=A comparison of enalapril 20 mg once daily versus 10 mg twice daily in terms of blood pressure lowering and patient compliance. | journal=J Hypertens | year= 1999 | volume= 17 | issue= 11 | pages= 1627-31 | pmid=10608477 | doi= | pmc= | url= }} </ref> | |||
==Uses== | |||
===Hypertension=== | |||
{{main|Hypertension}} | |||
In hypertension, all ACE inhibitors have a similar degree of lowering the blood pressure.<ref name="pmid18843651">{{cite journal |author=Heran BS, Wong MM, Heran IK, Wright JM |title=Blood pressure lowering efficacy of angiotensin converting enzyme (ACE) inhibitors for primary hypertension |journal=Cochrane database of systematic reviews (Online) |volume= |issue=4 |pages=CD003823 |year=2008 |pmid=18843651 |doi=10.1002/14651858.CD003823.pub2 |url=http://dx.doi.org/10.1002/14651858.CD003823.pub2 |issn=}}</ref>. At half of the maximum dose, the average reduction in blood pressure is -8/-5 mm Hg. | |||
===Heart failure=== | |||
{{main|Heart failure}} | |||
Angiotensin-converting enzyme inhibitor can reduce morbidity from [[heart failure]].<ref name="pmid7654275">{{cite journal |author=Garg R, Yusuf S |title=Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. Collaborative Group on ACE Inhibitor Trials |journal=JAMA |volume=273 |issue=18 |pages=1450–6 |year=1995 |month=May |pmid=7654275 |doi= |url= |issn=}}</ref> | |||
===Chronic kidney disease=== | |||
{{main|Chronic kidney disease}} | |||
===Vascular disease=== | |||
{{main|Vascular disease}} | |||
==Adverse effects== | |||
===Cough=== | |||
According to a [[clinical prediction rule]], [[cough]] due to angiotensin-converting enzyme inhibitors is more likely among patients who are "older age, female gender, non-African American (with East Asian having highest risk), no history of previous angiotensin-converting enzyme inhibitor use, and history of cough due to another angiotensin-converting enzyme inhibitor".<ref name="pmid15209608">{{cite journal |author=Morimoto T, Gandhi TK, Fiskio JM, ''et al'' |title=Development and validation of a clinical prediction rule for angiotensin-converting enzyme inhibitor-induced cough |journal=J Gen Intern Med |volume=19 |issue=6 |pages=684–91 |year=2004 |month=June |pmid=15209608 |pmc=1492376 |doi=10.1111/j.1525-1497.2004.30016.x |url=http://www.blackwell-synergy.com/openurl?genre=article&sid=nlm:pubmed&issn=0884-8734&date=2004&volume=19&issue=6&spage=684 |issn=}}</ref> | |||
===Angioedema=== | |||
Angiotensin-converting enzyme inhibitors may cause angioedema, which may be located in the bowel.<ref name="pmid21785085">{{cite journal| author=Scheirey CD, Scholz FJ, Shortsleeve MJ, Katz DS| title=Angiotensin-converting enzyme inhibitor-induced small-bowel angioedema: clinical and imaging findings in 20 patients. | journal=AJR Am J Roentgenol | year= 2011 | volume= 197 | issue= 2 | pages= 393-8 | pmid=21785085 | doi=10.2214/AJR.10.4451 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21785085 }} </ref> | |||
===Hypotension=== | |||
This may be more severe with angiotensin-converting enzyme inhibitors that have a longer half life such as enalapril.<!--<ref name="pmid10938492">{{cite journal |author=Vítovec J, Spinar J |title=First-dose hypotension after angiotensin-converting enzyme (ACE) inhibitors in chronic heart failure: a comparison of enalapril and perindopril. Slovak Investigator Group |journal=Eur. J. Heart Fail. |volume=2 |issue=3 |pages=299–304 |year=2000 |month=September |pmid=10938492 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S1388984200000957 |issn=}}</ref>--><ref name="pmid3018566">{{cite journal |author=Packer M, Lee WH, Yushak M, Medina N |title=Comparison of captopril and enalapril in patients with severe chronic heart failure |journal=N. Engl. J. Med. |volume=315 |issue=14 |pages=847–53 |year=1986 |month=October |pmid=3018566 |doi= |url= |issn=}}</ref> | |||
==References== | ==References== | ||
<references/> | <references/> | ||
Latest revision as of 21:20, 2 September 2011
Angiotensin-converting enzyme inhibitors (commonly ACE inhibitors) are a "class of drugs whose main indications are the treatment of hypertension and heart failure. They exert their hemodynamic effect mainly by inhibiting the renin-angiotensin system. They also modulate sympathetic nervous system activity and increase prostaglandin synthesis. They cause mainly vasodilation and mild natriuresis without affecting heart rate and contractility."[1]
Angiotensin-converting enzyme inhibitors also decrease the degradation of bradykinin as the enzyme kininase II is the same enzyme as angiotensin-converting enzyme.[2] This may contribute to some patients having a cough when taking angiotensin-converting enzyme inhibitors.
Examples
Enalapril should be prescribed twice daily.[3]
Uses
Hypertension
In hypertension, all ACE inhibitors have a similar degree of lowering the blood pressure.[4]. At half of the maximum dose, the average reduction in blood pressure is -8/-5 mm Hg.
Heart failure
Angiotensin-converting enzyme inhibitor can reduce morbidity from heart failure.[5]
Chronic kidney disease
Vascular disease
Adverse effects
Cough
According to a clinical prediction rule, cough due to angiotensin-converting enzyme inhibitors is more likely among patients who are "older age, female gender, non-African American (with East Asian having highest risk), no history of previous angiotensin-converting enzyme inhibitor use, and history of cough due to another angiotensin-converting enzyme inhibitor".[6]
Angioedema
Angiotensin-converting enzyme inhibitors may cause angioedema, which may be located in the bowel.[7]
Hypotension
This may be more severe with angiotensin-converting enzyme inhibitors that have a longer half life such as enalapril.[8]
References
- ↑ Anonymous (2024), Angiotensin-converting enzyme inhibitors (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Gainer JV, Morrow JD, Loveland A, King DJ, Brown NJ (October 1998). "Effect of bradykinin-receptor blockade on the response to angiotensin-converting-enzyme inhibitor in normotensive and hypertensive subjects". N. Engl. J. Med. 339 (18): 1285–92. PMID 9791144. [e]
- ↑ Girvin B, McDermott BJ, Johnston GD (1999). "A comparison of enalapril 20 mg once daily versus 10 mg twice daily in terms of blood pressure lowering and patient compliance.". J Hypertens 17 (11): 1627-31. PMID 10608477. [e]
- ↑ Heran BS, Wong MM, Heran IK, Wright JM (2008). "Blood pressure lowering efficacy of angiotensin converting enzyme (ACE) inhibitors for primary hypertension". Cochrane database of systematic reviews (Online) (4): CD003823. DOI:10.1002/14651858.CD003823.pub2. PMID 18843651. Research Blogging.
- ↑ Garg R, Yusuf S (May 1995). "Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. Collaborative Group on ACE Inhibitor Trials". JAMA 273 (18): 1450–6. PMID 7654275. [e]
- ↑ Morimoto T, Gandhi TK, Fiskio JM, et al (June 2004). "Development and validation of a clinical prediction rule for angiotensin-converting enzyme inhibitor-induced cough". J Gen Intern Med 19 (6): 684–91. DOI:10.1111/j.1525-1497.2004.30016.x. PMID 15209608. PMC 1492376. Research Blogging.
- ↑ Scheirey CD, Scholz FJ, Shortsleeve MJ, Katz DS (2011). "Angiotensin-converting enzyme inhibitor-induced small-bowel angioedema: clinical and imaging findings in 20 patients.". AJR Am J Roentgenol 197 (2): 393-8. DOI:10.2214/AJR.10.4451. PMID 21785085. Research Blogging.
- ↑ Packer M, Lee WH, Yushak M, Medina N (October 1986). "Comparison of captopril and enalapril in patients with severe chronic heart failure". N. Engl. J. Med. 315 (14): 847–53. PMID 3018566. [e]