Use of ACE inhibitors in Hypertension
ACE inhibitors inhibit the conversion of angiotensin I to angiotensin II, thereby producing vasodilation and lowering BP. Because the hydrolysis of bradykinin is also inhibited by these drugs, cough (7% to 12%) can occur. Angioedema (0.7%) can also occur via pathobiology that remains obscure, and its occurrence can be life-threatening. Like any drug that inhibits the renin-angiotensin system, ACE inhibitors can cause acute renal failure in patients with renal artery stenosis, and they are teratogenic. These drugs cause birth defects, even if given during the first trimester of pregnancy.
ACE inhibitors are usually effective in lowering BP, but their efficacy is reduced by dietary or other sources of sodium, and renal function may be further threatened if given with NSAIDs. ACE inhibitors are also very useful for patients with heart failure or CKD (particularly type 1 diabetics and nondiabetic CKD).
