Angiotensin-converting enzyme inhibitor

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This editable Main Article is under development and subject to a disclaimer.

[edit intro]

## Contents

* 1 Examples
* 2 Uses
* 2.1 Hypertension
* 2.2 Heart failure
* 2.3 Chronic kidney disease
* 2.4 Vascular disease
* 3 Adverse effects
* 3.1 Cough
* 3.2 Angioedema
* 3.3 Hypotension
* 4 References

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[edit]

Enalapril should be prescribed twice daily.[3]

## Uses[edit]

### Hypertension[edit]

For more information, see: 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[edit]

For more information, see: Heart failure.

Angiotensin-converting enzyme inhibitor can reduce morbidity from heart failure.[5]

### Chronic kidney disease[edit]

For more information, see: Chronic kidney disease.

### Vascular disease[edit]

For more information, see: Vascular disease.

## Adverse effects[edit]

### Cough[edit]

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[edit]

Angiotensin-converting enzyme inhibitors may cause angioedema, which may be located in the bowel.[7]

### Hypotension[edit]

This may be more severe with angiotensin-converting enzyme inhibitors that have a longer half life such as enalapril.[8]

## References[edit]

1. ↑ Anonymous (2025), Angiotensin-converting enzyme inhibitors (English). Medical Subject Headings. U.S. National Library of Medicine.
2. ↑ 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]
3. ↑ 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]
4. ↑ 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.
5. ↑ 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]
6. ↑ 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.
7. ↑ 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.
8. ↑ 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]