Angiotensin-converting enzyme (ACE) inhibitors are now the established first-line treatment in younger patients with hypertension and are also extensively used to treat heart failure. They are known to be less effective in treating hypertensive Afro-Caribbean patients. ACE inhibitors are also used to treat diabetic nephropathy and have a role in secondary prevention of ischaemic heart disease.
Mechanism of action: inhibit the conversion angiotensin I to angiotensin II Side-effects: cough: occurs in around 15% of patients and may occur up to a year after starting treatment. Thought to be due to increased bradykinin levels angioedema: may occur up to a year after starting treatment hyperkalaemia first-dose hypotension: more common in patients taking diuretics Cautions and contraindications pregnancy and breastfeeding - avoid renovascular disease - significant renal impairment may occur in…
