ACE Inhibitors

ACE Inhibitors

These affect the renin-angiotensin system (RAS), which mediates vascular endothelial dysfunction. In particular, angiotensin II is known to participate in the development of atherosclerosis through its effects on smooth muscle cell growth and proliferation Several clinical trials have demonstrated their therapeutic effects in atherosclerotic vascular disease ³².

Cautions

Should be used with caution in receiving diuretics as first doses may cause rapid hypotension, especially in those taking diuretics, on a low sodium diet, dehydrated or with heart failure. Initial doses should therefore be very low and closely supervised, and in some patients the diuretic dose may need to be reduced or the diuretic discontinued for at least 24 hours beforehand. They should also be used with caution in peripheral vascular disease or generalised atherosclerosis due to risk of clinically silent vascular disease. Renal function should be monitored before and during treatment, and the dose reduced in renal impairment. The risk of agranulocytosis is possibly increased in collagen vascular disease. Avoid in patients with a history of idiopathic or hereditary angiedema. Use with caution in breast feeding

Contra-indications

ACE inhibitors are contra-indicated in patients with known hypersensitivity and in known or suspected renovascular disease, aortic stenosis or outflow tract obstruction. They should not be used in pregnancy

Side effects

Profound hypotension, renal failure, persistent dry cough, angiodema, rash, pancreatitis, upper respiratory tract symptoms such as sinusitis, rhinitis, sore throat. Gastro-intestinal effects include nausea, vomiting, dyspepsia, diarrhoea, constipation. Altered liver function tests, cholestatic jaundice and hepatitis have been reported. Blood dyscrasias including thromobocytopenia, leucopenia, neutropenia and haemolytic anaemia. Headache dizziness, fatigue, malaise, taste disturbance, paraesthesis, bronchospasm, fever, serositis, vasculitis, myalgia, arthralgia, positive antinuclear antibody, raised erythrocyte sedimentation rate, eosinophilia, leucocytosis, photosensitivity