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Angiotensin converting enzyme inhibitors are one of the most important groups of drugs used to lower blood pressure and heart failure. These substances have many advantages. They show nephroprotective, antiatherosclerotic and antithrombotic effects. For this reason, they are often recommended in patients suffering from hypertension and in the presence of diabetic nephropathy. However, the use of these drugs is associated with numerous side effects. What should you know about ACE inhibitors?

Angiotensin converting enzyme inhibitorsare also often abbreviated ACE, derived from the English name angiotensin-converting-enzyme inhibitors. These drugs were initially introduced into therapy as substances used in hypertension. They can be administered alone in this disease or in combination with other preparations that lower blood pressure.

These drugs also have the ability to reduce hypertrophic cardiomyopathy and inhibit pathological remodeling of the heart muscle after infarction.

Later studies have shown that these drugs have a number of therapeutic properties useful in the treatment of other cardiovascular and nephrological diseases. ACEs are used in the treatment of:

  • acute myocardial infarction
  • heart failure
  • diabetic complications related to kidney function - diabetic nephropathy
  • stable coronary artery disease
  • kidney failure
  • metabolic syndrome
  • chronic lower limb ischemia
  • in primary and secondary prevention of stroke

Angiotensin converting enzyme inhibitors are often the first medications prescribed by a doctor when hypertension is detected. They are especially recommended in patients who have diabetes coexisting with this disease.

As the disease progresses, there is often a need to introduce more drugs into therapy in order to achieve the desired improvement. There are combination preparations, which are combinations of two substances, the use of which leads to a reduction in the number of tablets taken. Angiotensin converting enzyme inhibitors are present on the market in a combined form with thiazides.

Belonging to the angiotensin converting enzyme inhibitors, captopril is a drug often used as a relief in case of sudden jumpspressure. This is due to the good absorption of the drug, which results in a rapid antihypertensive effect. Its effectiveness is felt just 15 minutes after taking it.

The need for frequent use of ad hoc captopril indicates the ineffectiveness of the treatment method and should be reported to the attending physician.

Substances classified as angiotensin converting enzyme inhibitors and preparations containing them

  • captopril
  • cylazapryl
  • enalapryl
  • imidapryl
  • lisinopril
  • perindopril
  • quinapril
  • ramipryl
  • trandolapryl
  • zofenopryl

There are also many combined preparations containing one substance from the group of angiotensin converting enzyme inhibitors and another component with a different mechanism of action. It could be a substance belonging to, for example, calcium channel blockers or diuretics. Examples of such preparations:

  • amlodipine + ramipril
  • hydrochlorothiazide + zofenopril

Mechanism of ACE inhibitors

ACE works by blocking the enzyme responsible for converting angiotensin I to angiotensin II, which is responsible for constricting blood vessels. As a result, their relaxation occurs, and thus the blood pressure drops.

Angiotensin II affects the nervous system by increasing the production of vasopressin, a hormone that increases the volume of water in the body. It also acts on the smooth muscles of the veins and arteries, causing vasoconstriction.

Angiotensin II is also responsible for increasing the secretion of aldosterone, which is a hormone that regulates the body's water and mineral balance.

ACE inhibit the synthesis of angiotensin II, lowering its concentration in the body. Consequently, they reduce the volume of blood while increasing the volume of blood vessels. This action makes angiotensin inhibitors the main drugs in the treatment of high blood pressure.

Reducing the production of angiotensin II after the use of ACE also inhibits the release of aldosterone from the adrenal cortex. As a result, these drugs affect the work of the kidneys.

Increase the excretion of sodium ions with water into the urine, while retaining potassium in the body. This reduces the blood volume, which leads to a reduction in blood pressure.

How to take angiotensin converting enzyme inhibitors

At the start of therapy, the doctor will usually prescribe a very small dose of the drug. It is gradually increased with the duration of treatment until a well-tolerated and effective amount of the active substance is achieved.

Drugs from the group of convertase inhibitorsangiotensin is usually taken once a day, at a time independent of a meal.

The effects of drugs may sometimes be imperceptible to the patient on a daily basis. The recommendation for their use may also be incomprehensible due to the many different conditions, other than hypertension, for which they are attributed.

However, their regular use as recommended by a doctor is important for the long-term effectiveness of the therapy.

Angiotensin converting enzyme inhibitors - what to watch out for?

When using this group of drugs, it is extremely important to measure your blood pressure regularly. These results should be recorded and consulted with a doctor during check-up visits. You should also pay attention to the worsening of the disease symptoms. Problems of this type should also be reported to a specialist.

ACE inhibitors are potassium-sparing drugs. Their use can lead to a state called hyperkalemia, where the concentration of this element in the blood is too high.

For this reason, it is worthwhile to check the level of electrolytes and kidney function during ACE therapy.

While taking angiotensin converting enzyme inhibitors, you should improve your lifestyle. It is recommended to follow a proper diet, quit smoking and limit alcohol.

ACE inhibitors - side effects

Research shows that as many as 8 to 19% of patients discontinue treatment with ACE preparations due to troublesome side effects.

The following may occur during the use of angiotensin converting enzyme inhibitors:

  • cough
  • taste disturbance
  • renal dysfunction
  • angioedema
  • hyperkalemia
  • cytopenia
  • orthostatic hypotension
  • dizziness

Interactions of angiotensin converting enzyme inhibitors with other drugs

Quinapril reduces the absorption of tetracycline antibiotics.

Angiotensin converting enzyme inhibitors administered with potassium-containing drugs may lead to hyperkalemia. Symptoms of this condition are:

  • pain and tingling in the muscles
  • balance and motor coordination disorders
  • heart rhythm disturbance

Using ACE with other drugs that increase potassium levels can lead to an excess of this element in the body. These preparations are often referred to as "potassium-retaining" preparations. This group includes, among others: spironolactone, amiloride and triamterene.

Angiotensin converting enzyme inhibitors in combination with lithium carbonate can lead to excess lithium levels in theblood.

NSAIDs may reduce the blood pressure lowering effect of angiotensin inhibitors.

ACE inhibitors - contraindications

ACE drugs should not be used in the case of:

  • bilateral renal artery stenosis
  • stricture of the renal artery to the only functioning kidney
  • angioneurotic edema
  • allergic to the substance
  • severe hyperkalemia
  • pregnancy
  • end stage renal disease

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About the authorSara Janowska, MA in pharmacyPhD student of interdisciplinary doctoral studies in the field of pharmaceutical and biomedical sciences at the Medical University of Lublin and the Institute of Biotechnology in Białystok. A graduate of pharmaceutical studies at the Medical University of Lublin with a specialization in Plant Medicine. She obtained a master's degree defending a thesis in the field of pharmaceutical botany on the antioxidant properties of extracts obtained from twenty species of mosses. Currently, in his research work, he deals with the synthesis of new anti-cancer substances and the study of their properties on cancer cell lines. For two years she worked as a master of pharmacy in an open pharmacy.

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