ACE inhibitors are the most commonly prescribed medication for hypertension and heart disease as well.
They are one of the first-choice drugs in all grades of essential as well as renovascular hypertension except bilateral renal artery stenosis
ACE Inhibitors disturb the pathway of the renin-angiotensin-aldosterone system
(RAAS) by inhibiting – Angiotensin Converting Enzyme.
ACE inhibitors are classical drug to treat hypertension, heart problems and other conditions.They have better efficacy with diuretics and across the cardiovascular spectrum and renal dysfunction, it significantly reduces the mortality rate and improves the quality of life.
If you are having side effects like cough and angioedema from these drugs, your doctor may switch you on ARB (Angiotensin Receptor Blocker) – losartan, telmisartan etc. or other antihypertensive drugs.
ANGIOTENSIN CONVERTING ENZYME INHIBITORS
Angiotensin converting enzyme inhibitors are used as Antihypertensive drugs. • They inhibit generation of angiotensin II, which is a potent vasoconstrictor. • They inhibit the degradation of bradykinin, which is potent vasodilator. • They stimulate the synthesis of vasodilation PGs through bradykinin. • reduce sympathetic nervous system activity.
MECHANISM OF ACTION
▪ACE inhibitors also reduce aldosterone production hence sodium and water retention.
▪They dilate both arteries as well as veins, hence they reduce afterload and preload.
▪All these actions contribute to their Antihypertensive effect.
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ACE inhibitors are usually given orally. ▪ in emergency, enalapril can be given intravenously. ▪ Food reduces absorption of captopril hence it should be given 1 hour before meals. ▪ they poorly cross the BBB. ▪ Metabolized in liver and excreted in urine.
ADVERSE EFFECT 1. Cough 2.Angioedema. 3. Proteinuria. 4. Taste alteration. 5. Teratogenic effect. 6. Severe hypotension may occur 1-2 hour after taking first dose. 7. Neutropenia. 8. Rashes. 9. Itching. 10. Loss of appetite, nausea, vomiting, diarrhea.
USES OF ACE INHIBITORS
1 Hypertension: use of ACE inhibitors reduces the incidence of heart disease in hypertensive patient. ACE inhibitors are useful in all grades of hypertension. 2 Congestive cardiac failure: ACE inhibitors should be prescribed to all patients with inpaired left ventricular function. 3 Myocardial infarction: ACE inhibitors should be started within 24 hours in patients with MI. 4 Diabetic nephropathy: ACE inhibitors are preferred in diabetic nephropathy as they control both systemic hypertension and intraglomerular pressure. 5 Scleroderma renal crisis: ACE inhibitors produce dramatic improvement in patients with renal crisis and accelerated hypertension.
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