anti hypertensive drugs_ace inhibitor

8/3/2019 Anti Hypertensive Drugs_ACE Inhibitor

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ACE Inhibitors

PHRM 306: Drugs affecting CVS


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Introduction

The ACE inhibitors are recommended when

the preferred first-line agents (diuretics or -

blockers) are contraindicated or ineffective.

Despite their widespread use, it is not clear if

antihypertensive therapy with ACE inhibitors

increases the risk of other major diseases.


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Classification

Dicarboxylate-

containing ACE

inhibitors

EnalaprilRamipril

Quinapril

Perindopril

LisinoprilBezazepril

Moexipril

Sulfhydryl-

containing ACE

inhibitors

Captopril

Phosphonate-

containing ACE

inhibitors

Fosinolpril


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Actions

The ACE inhibitors lower blood pressure by

reducing peripheral vascular resistance

without reflexively increasing cardiac output,

rate, or contractility.

These drugs block the ACE that cleaves

angiotensin I to form the potent

vasoconstrictor angiotensin II.


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Figure

Effects of angiotensin-converting enzyme (ACE)

inhibitors.


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Actions

The converting enzyme is also responsible for

the breakdown of bradykinin.

ACE inhibitors decrease angiotensin II andincrease bradykinin levels.

Vasodilation occurs as a result of the

combined effects of lower vasoconstriction

caused by diminished levels of angiotensin II

and the potent vasodilating effect of increased

bradykinin.


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Actions

By reducing circulating angiotensin II levels,

ACE inhibitors also decrease the secretion of

aldosterone, resulting in decreased sodium

and water retention.


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Therapeutic uses

Like -blockers, ACE inhibitors are most

effective in hypertensive patients who are

white and young.

However, when used in combination with a

diuretic, the effectiveness of ACE inhibitors is

similar in white and black patients with

hypertension.


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Therapeutic uses

Along with the angiotensin-receptor blockers

(ARBs), ACE inhibitors slow the progression of

diabetic nephropathy and decrease

albuminuria.

ACE inhibitors are also effective in the

management of patients with chronic heart

failure.


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Therapeutic uses

ACE inhibitors are a standard in the care of a

patient following a myocardial infarction.

Therapy is started 24 hours after the end of

the infarction.


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Adverse effects

Common side effects include dry cough, rash,

fever, altered taste, hypotension (in

hypovolemic states), and hyperkalemia.


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Adverse effects

The dry cough, which occurs in about 10

percent of patients, is thought to be due to

increased levels ofbradykinin in the

pulmonary tree. (mainly women)

Angioedema (rash) is a rare but potentially

life-threatening reaction and may also be due

to increased levels of bradykinin.


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Adverse effects

Hyperkalemia: Potassium levels must be

monitored, and potassium supplements (or a

high potassium diets) or potassium-sparing

diuretics are contraindicated.

Because of the risk ofangioedema and first-

dose syncope, ACE inhibitors may be first

administered in the physician's office with

close observation.


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Adverse effects

Reversible renal failure can occur in patients

with severe bilateral renal artery stenosis.

ACE inhibitors are fetotoxic and should not beused by women who are pregnant.

anti hypertensive drugs_ace inhibitor

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