Angiotensin-Converting Enzyme (ACE) Inhibitors

What are Angiotensin-Converting Enzyme (ACE) Inhibitors?

Angiotensin-Converting Enzyme Inhibitors or ACE-I are drugs that are commonly prescribed for treating hypertension (high blood pressure) and various heart conditions.

How It Works

ACE is an enzyme that helps to form a chemical known as angiotensin II in the body. The function of angiotensin II is to constrict or narrow the blood vessels which in turn increases blood pressure. Angiotensin II is also responsible for secreting certain hormones in the body that help regulate the body's water and sodium reabsorption through the kidneys.

The retention of water and sodium by kidneys raises the blood pressure and the load of blood volume reaching the heart. The increase in blood pressure and blood volume load boosts the heart's workload.

ACE inhibitors prevent the formation of angiotensin II in the body, thereby lowering blood pressure by dilating or expanding the blood vessels. This way, the medication helps to lower blood pressure and reduce the work load of the heart.

What Is It Prescribed for?

1. Hypertension (high blood pressure)
2. Heart failure
3. Diabetic with high blood pressure
4. Chronic kidney disease
5. Stroke
6. Heart and vascular disease in diabetic and hypertensive patients
7. Kidney disease like nephropathy or treating nephropathy in patients with high blood pressure or diabetes
8. After heart attacks - Studies have shown that people prescribed ACE-I after a heart attack have lower chances of a repeat heart attack. Studies also indicate that prescribing ACE-I for patients with heart failure, lower left ventricular function live longer.

Examples of ACE-I include:

• CaptoprilE
• nalaprilLisi
• noprilRami
• prilBenaze
• prilFosinop
• rilMoexipri
• lQuinaprilT
• randolapril

What are the Side Effects of Angiotensin-Converting Enzyme (ACE) Inhibitors?

1. Dry Cough- It is the most common side effect seen in 5-20% of the patients treated with ACE-I. Normally ACE break downs prostaglandins like bradykin in and substance pin the body. During ACE-I administration there is an accumulation of the prostaglandins which lead to cough which is usually resolved in 1-4 days after discontinuing the drug.
2. Hyperkalemia- Increased potassium levels in the blood
3. Dizziness due to low blood pressure
4. Angioedema- Rare adverse event. Seen in 0.1-0.2% of patients taking ACE-I. It involves swelling up of tissues of the face, lips and throat. It can belief threatening when tissues of the throat swell up, compromising the airway. This is seen more commonly in African Americans, smokers, women, people on immunosuppressive medication, people with a history of drug rash, seasonal allergies, and older people.
5. Fatigue, headache, altered sense of smell, syncope (fainting) - Other rare side effects were reported in 1-10%of patients.

Drug Interaction

• Non-Steroidal Anti-Inflammatory Drugs (NSAID's) like ibuprofen decrease the effectiveness of ACE-I. Occasional use of NSAIDs may not cause significant changes, long term users should consult with their doctor.
• ACE-I should not be taken during pregnancy as it is harmful to the baby.

Cost

• US - $10-30 for 30 tablets
• India - Rs.480 to1500 for 30 tablets

References

1. Patel S, Rauf A, Khan H, Abu-Izneid T. Renin-angiotensin-aldosterone (RAAS): The ubiquitous system for homeostasis and pathologies. Biomed Pharmacother. 2017Oct;94:317-325. doi:10.1016/j.biopha.2017.07.091.Epub2017Jul31.PMID:28772209.
2. Hradec J. Pharmacological therapy for chronic heart failure.VnitrLek.2018Fall;64(9):853-859.English.PMID:30441998.
3. Heart Outcomes Prevention Evaluation Study Investigators, YusufS, SleightP, PogueJ, BoschJ, DaviesR, DagenaisG. Effects of anangiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med. 2000 Jan 20;342(3):145-53. doi:10.1056/NEJM200001203420301.Erratumin:2000May4;342(18):1376.Erratumin:NEnglJMed 2000Mar9;342(10):748.PMID:10639539.
4. IsrailiZH, HallWD. Cough and angioneurotic edema associated with angiotensin-converting enzyme inhibitor therapy. Are view of the literature and pathophysiology.AnnInternMed.1992Aug1;117(3):234-42.doi:10.7326/0003-4819-117-3-234.PMID:1616218.
5. GoyalA,CusickAS,ThielemierB. ACEInhibitors. [Updated2020Aug10]. In:StatPearls[Internet].TreasureIsland(FL):StatPearlsPublishing;2021Jan-.(https://ncbi.nlm.nih.gov/books/NBK430896/)
6. Pol�nia J. Interaction of antihypertensive drugs with anti-inflammatory drugs. Cardiology.1997;88Suppl3:47-51.�doi:10.1159/000177507.PMID:9397294.

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