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|What Are ACE Inhibitors?
ACE (angiotensin-converting enzyme) inhibitors are a group of drugs which are commonly used for the treatment of high blood pressure. ACE medications can be given alone or in combination with other blood pressure drugs (antihypertensives). They are also given to patients:
1. After a heart attack to improve the function of the heart.
2. To treat congestive heart failure where the heart is weak and cannot pump blood efficiently.
3. Who have kidney problems due to type 1 diabetes.
Common Brand Names
There are various different types of ACE inhibitors and all generic versions end in the letters -pril. These include:
|Generic Drug Name
How Do They Work?
ACE-I's appear to work by restricting an enzyme in the body responsible for converting inactive angiotensin 1 into angiotensin 2. Angiotensin 2 causes blood vessels to constrict which increases blood pressure. Reducing levels of angiotensin 2 in the body allows the vessels to dilate and thus reduces blood pressure.
What Are ARBs?
ARBs (angiotensin-receptor blockers) block the effect of angiotensin 2 (whereas ACE drugs lower the level). Both types of drugs do very much the same thing - they prevent the effects of angiotensin 2's on the blood vessels and heart. Generally however ARBs are only prescribed to patients who are not able to take ACE-I's.
What Do They Do?
ACE-I's cause blood vessels to relax, the vessels expand and blood pressure goes down. This also decreases the workload on the heart. ACE drugs are the preferred method of treatment for high blood pressure in patients who also suffer from heart failure or have a history of kidney disease.
ACE-I's can prevent the progression of heart failure by lowering blood pressure which reduces stress and workload on the heart. Also, the presence of angiotensin 2 can cause the muscle of the heart to remodel itself (ventricular remodeling) after damage due to a heart attack or stroke. This remodeling process means the heart changes size, shape and function, becoming less efficient in the process. By stopping the production of angiotensin 2, ACE-I's directly prevent remodeling and further weakening of the heart. If you are prescribed ACE-I's after a heart attack, you will probably need to continue taking them for life.
Chronic Kidney Disease
People with chronic kidney disease, and particularly those kidney disease caused by diabetes (diabetic nephropathy), significantly benefit from taking ACE-I's. This is because angiotensin 2 causes the blood vessels in the kidneys to constrict which means pressure can build up in the kidneys. Over time this can lead to kidney failure. ACE-I's can slow the progression of kidney damage by keeping the vessels relaxed and dilated.
What Are The Side Effects?
ACE inhibitors tend to raise the levels of potassium in the blood, so it is particularly important to inform your doctor if you are taking potassium supplements, using salt substitutes (which often contain potassium) or are drinking low salt milk (which can increase potassium levels). Also, always check with your doctor before mixing ACE-I's with herbal supplements or any other over the counter remedies. A high level of potassium, a condition called Hyperkalemia, does not usually cause symptoms until levels are dangerously high. If you do experience symptoms, you may feel weak, nauseous or generally unwell. A weak pulse or slow heartbeat is a more serious sign as this signals a problem with the heart's electrical activity (heart arrhythmia). Potassium is responsible for maintaining a normal heart beat, a severe disruption in electrical impulses can cause the heart to stop working. If you are taking ACE-I's, your doctor may periodically check your potassium blood levels.
About 20 percent or more of patients who take ACE-I's develop a dry cough. The cough may become severe enough to require discontinuation of the medication or switching to ARBs (the risk is higher for some reason in black and Asian women). The cough usually clears within a few days of discontinuation or switching but it can take up to several weeks to completely clear. If the patient needs to continue taking ACE-I's, despite having a cough, then they may be prescribed cromolyn, baclofen or theophylline to ease symptoms. Some studies show that patients may also benefit from taking Clinoril (generic name sulindac) which is a non-steroidal anti-inflammatory (NSAIDs). Two other studies reported benefits by taking 500mg of aspirin a day to suppress the cough. An iron supplement may also help.
Low Blood Pressure
As with any medications which lower blood pressure, ACE-I's and ARBs can cause hypotension - that is, low blood pressure.
Other Possible Side Effects Include:
• Angioedema - sudden swelling of the face and neck.
• Skin rash.
• Loss of taste.
• Fever and chills.
• Trouble swallowing.
• Upset tummy.
• Kidney damage, in rare instances.
Pregnancy And ACE Inhibitors
If you are taking ACE inhibitors for lowering blood pressure and are planning pregnancy, notify your doctor. According to a study reported in the New England Journal of Medicine (2006), infants whose mothers had taken ACE-I's during the first trimester of pregnancy had an increased risk of developing birth defects than those who had not. According to current FDA regulations, ACE-I's are labeled as pregnancy category C drugs for the first trimester but category D (more harmful) in the second and third trimester of pregnancy. Patients who take ACE-I's and become pregnant are usually encouraged to stop taking them as soon as possible. Currently the FDA does not plan on changing the drug categories at this time, but it recommends that prenatal healthcare teams should take this study into account when considering a woman's care in early pregnancy.
Note: If you do take blood pressure medications and become pregnant, but sure to tell your obgyn about all medicines you are taking, including over the counter supplements, herbal remedies and aspirin (see aspirin during pregnancy). Other useful articles include heart disease in pregnancy and Tylenol while pregnant.