ACE Inhibitors - First Line Medication for Hypertension

What Are ACE Inhibitors?

Angiotensin-converting enzyme inhibitors (ACEIs) are commonly used medications to treat heart and blood vessel diseases. Angiotensin is produced by the body and helps in the contraction of the blood vessels, causing an increase in blood pressure. Angiotensin-converting enzyme inhibitors are medications that inhibit the activity of the ACE enzyme causing dilatation of the blood vessels and reduced blood pressure. This improves the functioning of the heart. ACE inhibitors have a synergistic effect and work well when prescribed with diuretics and calcium channel blockers.

Why Are ACE Inhibitors Used?

• Hypertension - ACE Inhibitors are effective in treating cardiovascular conditions such as hypertension (high blood pressure), and coronary artery disease. The enzymes effectively lower the mean arterial blood pressure and blood pressure in hypertensive and normotensive patients.

• Heart Failure - These inhibitors improve heart failure by decreasing afterload, preload, and systolic wall stress. ACE inhibitors reduce cardiac myocyte hypertrophy and are the first choice therapy in patients with heart failure.

• Heart Attacks - ACE inhibitors are used to prevent heart attacks and stroke in people at high risk.

• Diabetes - Treatment with ACE inhibitors in patients with left ventricular dysfunction reduces the progression to congestive heart failure after myocardial infarction. ACE inhibitors are the first-line therapy for hypertension with a history of diabetes. The use of ACE inhibitors decreases the incidence of myocardial infarction and improves heart function.

• Proteinuria - Angiotensin-converting enzyme inhibitors provide protection against proteinuria and stabilize renal function in previously untreated patients.

• Glomerular Disease - ACE inhibitors are the first line of treatment in managing chronic kidney disease and glomerular disease patients.

How Do ACE Inhibitors Work?

• The ACE inhibitors block the angiotensin-converting enzyme from converting angiotensin I into angiotensin II. Angiotensin II stimulates the release of aldosterone and sodium absorption, thereby increasing blood volume and blood pressure.

• The ACE inhibitors stimulate the dilation of blood vessels by inhibiting the production of angiotensin II. These inhibitory effects lead to increased sodium and urine excretion, increased venous capacity, and decreased cardiac output, stroke work, and volume.

• ACE inhibitors also block the breakdown of bradykinin and cause a rise in protein and vasodilation of blood vessels.

How to Take ACE Inhibitors?

ACE inhibitors are commonly administered orally, except for Enalapril, which can be given intravenously. The ACE inhibitors are given without food. The ACE inhibitors should be taken in the amount recommended by the doctor and at the same time each day. It is advised to reduce salt substitutes while taking ACE inhibitors as they can cause potassium retention in the body. The medication works best when taken at bedtime. This is because they can reduce the effect of hormone that is most active during sleep. They are typically safe to be taken for long-term use. Therapy with ACE inhibitors should not be stopped without talking to the doctor. Always keep the medicine protected from heat, direct light, and moisture.

What Are the Various Types of ACE Inhibitors and Their Dosage?

ACE inhibitors can be effective for short-term and long-term treatments. Some of the common ACE inhibitors and their dosages include

What Are the Common and Serious Side Effects of ACE Inhibitors?

Side effects of ACE inhibitors may include

• Dry cough.

• Fatigue.

• Dizziness from blood pressure going too low.

• Headaches.

• Loss of taste.

• Itchy skin.

• Angioedema.

• Drowsiness.

• Weakness.

Severe side effects include

• Severe dry cough.

• Swelling of face, eyes, mouth, lips, tongue, legs, or feet.

• Jaundice.

• Allergic reactions.

• Increased potassium levels in the blood can be life-threatening. Signs of increased potassium levels in the body include confusion, difficulty breathing, irregular heartbeat, numbness or tingling in hands, feet, or lips.

Missed Dose:

If you miss a dose of an ACE inhibitor, it is advised to take the missed dose as soon as you remember. However, you should not double the dose as it can cause a severe, dangerous fall in blood pressure.

What Are the Interactions of ACE Inhibitors?

Interactions With Other Medicines:

• Ibuprofen.

• Naproxen.

• NSAIDs (nonsteroidal anti-inflammatory drugs) such as Aspirin, Indomethacin.

• Aliskiren.

• Tetracycline.

• Lithium.

Interaction With Food:

• High Sodium Diet - Eating a diet high in salt can reduce the effectiveness of ACE inhibitors in lowering blood pressure.

• Capsaicin - Taking capsaicin with food while taking ACE inhibitors can worsen the ACE inhibitor-related cough.

• Food High in Potassium - Foods such as avocados, beetroot, oranges, potatoes, spinach, tomatoes, and tomato sauce should be avoided in large amounts by people taking ACE inhibitors.

Interaction With Disease:

• Bone Marrow Suppression - ACE inhibitors can cause bone marrow depression in patients with renal impairment and should be administered cautiously in patients with preexisting blood dyscrasias.

• Congestive Heart Failure - ACE inhibitors can cause oliguria and excessive hypotension. Therapy with ACE inhibitors should be monitored closely until the blood pressure and renal function are stabilized.

• Hyperkalemia - Therapy with ACE inhibitors should be monitored in patients with predisposed hyperkalemia for their serum potassium levels.

What Are the Drug Warnings and Precautions for ACE Inhibitors?

• Pregnant Women - ACE inhibitors should not be taken during pregnancy as they can increase the risk of adverse events for pregnant women. It can affect the embryo and fetus's development and, therefore, should be avoided.

• Breastfeeding Women - Angiotensin II receptor antagonists should not be used by breastfeeding women in the first week after delivery as the medicine can pass through breast milk.

• Children - ACE inhibitors should be given with caution in children as they are at higher risk of severe side effects, such as severe dry cough and allergic reactions.

• History of Angioedema - ACE inhibitors are contraindicated in patients with past reactions to an ACE inhibitor. It can cause symptoms such as swelling of the face, tongue, and throat, and trouble breathing and swallowing.

• Severe Kidney Disease - Angiotensin-converting enzyme inhibitors should be administered with caution in patients with severe kidney disease or renal artery stenosis.

• Geriatrics - ACE inhibitors should be given with caution in the elderly, and the doses should be adjusted accordingly.

• Liver Disease - Therapy with ACE inhibitors should be administered cautiously in patients with liver issues.

• Diabetic Nephropathy - Taking ACE inhibitors can exacerbate proteinuria and progress to kidney failure in patients with diabetic nephropathy.

• Alcohol - Drinking alcohol can increase the blood pressure-lowering effect of Lisinopril and can make one feel dizzy or lightheaded.

Conclusion:

ACE inhibitors are important agents to treat and prevent various heart problems and should not be discontinued unless instructed by your doctor. It is, however, important to maintain a healthy lifestyle to control and manage your heart health.