18.2 Angiotensin-Converting Enzyme (ACE) Inhibitors
3 min read•june 18, 2024
are a crucial class of medications that target the ###-Angiotensin-Aldosterone_System_0###. By blocking the conversion of to , they help lower blood pressure and improve cardiovascular health.
These drugs are commonly used to treat , , and prevent complications after heart attacks. While generally well-tolerated, ACE inhibitors can cause side effects like and require careful monitoring of blood pressure and kidney function.
Renin-Angiotensin-Aldosterone System (RAAS) and ACE Inhibitors
Mechanism of ACE inhibitors
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- Block conversion of angiotensin I to angiotensin II by inhibiting
- Angiotensin II acts as a potent vasoconstrictor increases blood pressure (BP)
- Stimulates release of leads to sodium and water retention
- Reducing angiotensin II levels causes:
- decreases peripheral vascular resistance lowers BP (amlodipine)
- Reduced secretion increases sodium and water excretion decreases blood volume (furosemide)
- Increase levels contributes to vasodilation and BP reduction
Blood Pressure Regulation and RAAS
- Renin is released by the kidneys in response to decreased blood pressure
- Renin converts to angiotensin I
- ACE converts angiotensin I to angiotensin II
- Angiotensin II causes and increases blood pressure
- RAAS affects function, regulating sodium and water reabsorption
- ACE inhibitors improve , promoting cardiovascular health
Common ACE inhibitors and indications
- ()
- Hypertension
- Heart failure
- (MI)
- ()
- Hypertension
- Heart failure
- (, )
- Hypertension
- Heart failure
- Post-MI
- ()
- Hypertension
- (stroke prevention)
- ()
- Hypertension
- (CKD)
Adverse effects of ACE inhibitors
- Common adverse effects:
- Dry cough due to increased bradykinin levels
- especially with first dose or in volume-depleted patients (diuretics)
- due to reduced aldosterone secretion
- particularly in patients with pre-existing renal impairment or renal artery stenosis
- (rare but potentially life-threatening)
- Swelling of face, lips, tongue, and throat
- More common in African American patients
- Drug interactions:
- Potassium supplements and (spironolactone) increased risk of hyperkalemia
- (ibuprofen) may attenuate antihypertensive effect increase risk of renal dysfunction
- Lithium increased lithium levels and toxicity risk
- Contraindicated in pregnancy due to potential fetal harm ()
Nursing considerations for ACE inhibitors
- Assess BP, renal function, and electrolytes (especially potassium) before initiating therapy and periodically during treatment
- Monitor for signs and symptoms of angioedema such as swelling of face, lips, tongue, or throat
- Instruct patients to seek immediate medical attention if angioedema occurs
- Advise patients to report persistent dry cough as this may necessitate switching to another antihypertensive class (ARBs)
- Educate patients on importance of adhering to prescribed dosing schedule and not discontinuing medication without consulting healthcare provider
- Instruct patients to rise slowly from sitting or lying positions to minimize risk of
- Encourage patients to maintain healthy lifestyle including low-sodium diet (), regular exercise, and stress management
- Advise patients to avoid potassium supplements and salt substitutes containing potassium unless prescribed by healthcare provider
- Educate patients on signs and symptoms of hyperkalemia such as muscle weakness, fatigue, and irregular heartbeat
- Stress importance of regular follow-up appointments to monitor BP, renal function, and electrolytes
Key Terms to Review (46)
ACE Inhibitors: ACE (Angiotensin-Converting Enzyme) inhibitors are a class of medications that work by blocking the action of the angiotensin-converting enzyme, which is responsible for converting angiotensin I into angiotensin II, a potent vasoconstrictor. By inhibiting this enzyme, ACE inhibitors help lower blood pressure and reduce the workload on the heart.
Aldosterone: Aldosterone is a hormone produced by the adrenal glands that regulates sodium and potassium balance in the blood. It plays a crucial role in controlling blood pressure.
Aldosterone: Aldosterone is a mineralocorticoid hormone produced by the adrenal glands that plays a crucial role in maintaining fluid and electrolyte balance in the body. It is a key component in the regulation of homeostasis, the renin-angiotensin-aldosterone system, and the management of various cardiovascular and renal conditions.
Altace: Altace is an angiotensin-converting enzyme (ACE) inhibitor medication used to treat high blood pressure, heart failure, and to improve survival after a heart attack. It works by blocking the enzyme that converts angiotensin I to angiotensin II, which helps relax and widen blood vessels, reducing the workload on the heart.
Angioedema: Angioedema is a sudden, rapid swelling of the deeper layers of the skin and mucous membranes, often caused by an allergic reaction or certain medications. It is a serious medical condition that can affect various parts of the body, including the face, lips, tongue, throat, and extremities.
Angiotensin I: Angiotensin I is a peptide hormone produced by the renin-angiotensin-aldosterone system (RAAS) in the body. It is a precursor to the more potent angiotensin II, which plays a crucial role in regulating blood pressure and fluid balance.
Angiotensin II: Angiotensin II is a potent vasoconstrictor hormone that plays a central role in the regulation of blood pressure and fluid balance within the body. It is a key component of the renin-angiotensin-aldosterone system (RAAS), which is a complex physiological pathway involved in maintaining homeostasis.
Angiotensin-Converting Enzyme (ACE): Angiotensin-converting enzyme (ACE) is a key enzyme involved in the regulation of blood pressure and fluid balance in the body. It plays a central role in the renin-angiotensin-aldosterone system, which is responsible for maintaining homeostasis of the cardiovascular and renal systems.
Angiotensin-converting enzyme (ACE) inhibitors: Angiotensin-converting enzyme (ACE) inhibitors are medications that relax blood vessels by preventing the formation of angiotensin II, a substance that narrows blood vessels. They are commonly used to treat high blood pressure and heart failure.
Angiotensinogen: Angiotensinogen is a protein precursor produced primarily in the liver that plays a crucial role in the renin-angiotensin-aldosterone system (RAAS), a key regulator of blood pressure and fluid balance within the body.
Benazepril: Benazepril is an angiotensin-converting enzyme (ACE) inhibitor used to treat high blood pressure. It works by relaxing blood vessels, making it easier for the heart to pump blood.
Black clients: Black clients are patients who identify as Black or African American. Special considerations in pharmacology may be necessary due to genetic, socio-economic, and cultural factors that affect drug efficacy and safety.
Blood Pressure Regulation: Blood pressure regulation is the physiological process by which the body maintains a stable and optimal blood pressure. This involves a complex interplay between the cardiovascular, nervous, and endocrine systems to control factors such as blood volume, vascular resistance, and cardiac output.
Bradykinin: Bradykinin is a potent vasodilator peptide that is generated by the cleavage of kininogen by the enzyme kallikrein. It plays a crucial role in the regulation of blood pressure and inflammatory responses within the context of Angiotensin-Converting Enzyme (ACE) Inhibitors.
Capoten: Capoten is an angiotensin-converting enzyme (ACE) inhibitor medication used to treat high blood pressure, heart failure, and other cardiovascular conditions by blocking the enzyme responsible for the production of angiotensin II, a potent vasoconstrictor that can lead to increased blood pressure.
Capto: Capto, commonly known as Captopril, is an Angiotensin-Converting Enzyme (ACE) inhibitor used to treat hypertension and heart failure. It works by relaxing blood vessels, allowing blood to flow more easily.
Captopril: Captopril is an angiotensin-converting enzyme (ACE) inhibitor used primarily to treat high blood pressure and heart failure. It works by relaxing blood vessels, making it easier for the heart to pump blood.
Cardiovascular Risk Reduction: Cardiovascular risk reduction refers to the strategies and interventions aimed at lowering an individual's risk of developing cardiovascular diseases, such as heart attacks, strokes, and other heart-related conditions. This term is particularly relevant in the context of Angiotensin-Converting Enzyme (ACE) Inhibitors, a class of medications that can help manage and reduce cardiovascular risk factors.
Chronic Kidney Disease: Chronic kidney disease (CKD) is a progressive condition characterized by the gradual loss of kidney function over time. It is a significant public health concern that can lead to various complications if left untreated, including fluid and electrolyte imbalances, hypertension, and ultimately, end-stage renal disease.
DASH Diet: The DASH (Dietary Approaches to Stop Hypertension) diet is a eating plan that emphasizes foods rich in nutrients that have been shown to help lower blood pressure, such as potassium, calcium, and magnesium. It is particularly relevant in the context of angiotensin-converting enzyme (ACE) inhibitors and cholesterol absorption inhibitors, as it can complement the effects of these medications in managing cardiovascular health.
Dry Cough: A dry cough is a type of cough that does not produce any mucus or phlegm. It is often described as a tickling, scratchy, or irritating sensation in the throat that triggers the cough reflex, but without the expulsion of respiratory secretions.
Enalapril: Enalapril is an Angiotensin-Converting Enzyme (ACE) inhibitor used primarily to treat hypertension and heart failure. It works by relaxing blood vessels and reducing the workload on the heart.
Endothelial Function: Endothelial function refers to the ability of the endothelium, the inner lining of blood vessels, to regulate vascular tone, blood flow, and maintain vascular homeostasis. It is a crucial factor in the context of various cardiovascular conditions and the mechanisms of action of certain drug classes.
Grades of hypertension: Grades of hypertension classify the severity of high blood pressure based on systolic and diastolic measurements. These grades help guide treatment decisions and risk assessment.
Heart Failure: Heart failure is a condition in which the heart is unable to pump blood effectively, leading to a reduced ability to meet the body's oxygen and nutrient demands. This term is closely connected to the topics of unclassified antidysrhythmics, angiotensin-converting enzyme (ACE) inhibitors, drugs affecting the renin-angiotensin-aldosterone system, oxygenation and gas exchange, and various diuretics, as these medications and physiological processes are often involved in the management and treatment of heart failure.
Hyperkalemia: Hyperkalemia is a medical condition characterized by an abnormally high concentration of potassium (K+) in the blood. This electrolyte imbalance can have significant impacts on the body's homeostasis and various physiological processes, including cardiac function, fluid balance, and nerve impulse transmission.
Hypertension: Hypertension, also known as high blood pressure, is a chronic medical condition in which the blood pressure in the arteries is elevated, increasing the risk of heart disease, stroke, and other health complications. It is a key term that is closely connected to various topics in pharmacology, including the management of cardiovascular conditions and the use of specific drug classes to control blood pressure.
Hypotension: Hypotension is a medical condition characterized by an abnormally low blood pressure, where the systolic blood pressure falls below 90 mmHg and the diastolic blood pressure falls below 60 mmHg. This can have significant implications on the body's ability to circulate blood and deliver oxygen and nutrients to vital organs.
Lisinopril: Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor used to treat hypertension and heart failure. It works by relaxing blood vessels, making it easier for the heart to pump blood.
Lotensin: Lotensin is the brand name for benazepril, an angiotensin-converting enzyme (ACE) inhibitor used to treat high blood pressure. It works by relaxing blood vessels, making it easier for the heart to pump blood.
Nephron: The nephron is the basic functional unit of the kidney, responsible for the filtration, reabsorption, and secretion of substances in the process of urine formation. This term is central to understanding the mechanisms of action and effects of various classes of drugs, including angiotensin-converting enzyme (ACE) inhibitors, diuretics, and drugs related to renal-associated fluid volume excess.
Nonsteroidal anti-inflammatory drugs (NSAIDs): Nonsteroidal anti-inflammatory drugs (NSAIDs) are medications that reduce inflammation, pain, and fever without the use of steroids. They inhibit cyclooxygenase enzymes (COX-1 and COX-2), which are involved in the production of prostaglandins.
NSAIDs: NSAIDs, or Non-Steroidal Anti-Inflammatory Drugs, are a class of medications that are widely used to reduce inflammation, alleviate pain, and lower fever. They work by inhibiting the production of prostaglandins, which are key mediators of the inflammatory response. NSAIDs are commonly employed in the management of various conditions, including arthritis, menstrual cramps, headaches, and post-operative pain.
Oligohydramnios: Oligohydramnios is a condition characterized by a deficiency of amniotic fluid surrounding the fetus during pregnancy. This term is particularly relevant in the context of Angiotensin-Converting Enzyme (ACE) Inhibitors, as these medications can potentially cause this complication.
Orthostatic Hypotension: Orthostatic hypotension is a sudden drop in blood pressure that occurs when an individual stands up from a sitting or lying position. This condition can lead to dizziness, lightheadedness, and even fainting, and is particularly relevant in the context of various medical conditions and drug therapies.
Post-Myocardial Infarction: Post-myocardial infarction refers to the period following a heart attack, or myocardial infarction, where the heart muscle has been damaged due to a lack of blood flow and oxygen supply. This critical time period involves various physiological and clinical considerations, particularly in the context of angiotensin-converting enzyme (ACE) inhibitor therapy.
Potassium-Sparing Diuretics: Potassium-sparing diuretics are a class of medications that work to increase the excretion of sodium and water from the body while simultaneously preventing the loss of potassium. This unique mechanism of action makes them particularly relevant in the context of angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), and other diuretic therapies.
Prinivil: Prinivil is a brand name for the angiotensin-converting enzyme (ACE) inhibitor drug lisinopril. ACE inhibitors are a class of medications used to treat high blood pressure, heart failure, and other cardiovascular conditions by inhibiting the enzyme responsible for the production of angiotensin II, a potent vasoconstrictor.
Ramipril: Ramipril is an angiotensin-converting enzyme (ACE) inhibitor, a class of medications used to treat high blood pressure, heart failure, and other cardiovascular conditions. As an ACE inhibitor, ramipril works by blocking the enzyme responsible for converting angiotensin I into angiotensin II, a potent vasoconstrictor, thereby reducing blood pressure and improving cardiovascular function.
Renal Dysfunction: Renal dysfunction refers to the impairment or failure of the kidneys to effectively perform their primary functions of filtering waste, regulating fluid balance, and maintaining electrolyte homeostasis. This term is particularly relevant in the context of Angiotensin-Converting Enzyme (ACE) Inhibitors and drugs affecting the Renin-Angiotensin-Aldosterone System, as these medications can have significant impacts on kidney function.
Renin: Renin is an enzyme produced by the kidneys that plays a crucial role in the regulation of blood pressure and fluid balance within the body. It is a key component of the renin-angiotensin-aldosterone system, which is central to the understanding of topics such as Angiotensin-Converting Enzyme (ACE) Inhibitors, Beta-Adrenergic Blockers, and drugs affecting the Renin-Angiotensin-Aldosterone System.
Renin-Angiotensin-Aldosterone System: The renin-angiotensin-aldosterone system (RAAS) is a complex physiological mechanism that regulates blood pressure, fluid balance, and electrolyte homeostasis in the body. It is a crucial system involved in the management of hypertension, heart failure, and other cardiovascular and renal conditions.
Vasoconstriction: Vasoconstriction is the narrowing or constriction of blood vessels, specifically the arteries and arterioles, which leads to a decrease in blood flow and blood pressure. This physiological process is an important mechanism in the regulation of blood flow and blood pressure throughout the body.
Vasodilation: Vasodilation refers to the widening or dilation of blood vessels, particularly the arteries and arterioles. This process leads to increased blood flow and reduced vascular resistance, which can have significant implications in various physiological and pharmacological contexts.
Vasotec: Vasotec is a brand name for enalapril, an angiotensin-converting enzyme (ACE) inhibitor used to treat high blood pressure and heart failure. It works by relaxing blood vessels, making it easier for the heart to pump blood.
Zestril: Zestril is a brand name for lisinopril, an angiotensin-converting enzyme (ACE) inhibitor used to treat high blood pressure and heart failure. It works by relaxing blood vessels, making it easier for the heart to pump blood.