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Question

Angiotensin converting enzyme (ACE) inhibitors are one of the more common medications used in the management of primary hypertension. What are some potential adverse reactions from and contraindications to using ACE inhibitors?

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Answer

• Cough
  • 10% of patient experience a dry, hacking cough
• Hypotension
  • 2% of patients can experience hypotension, weakness, or dizziness from excessive reduction in blood pressure
• Reduction in GFR
  • 2% of patients can see a doubling in creatinine due to decreased intrarenal perfusion as a result of increased efferent arteriole resistance
• Hyperkalemia
  • 3% of patients can have a potassium > 5.5 mEq/L by reducing urinary potassium excretion
• Angioedema
  • 0.3% of patients can experience potentially life-threatening angioedema
• Pregnancy
  • Associated with cardiac malformations in the first trimester and renal malformations in the second/third trimesters

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References

• Israili ZH, Hall WD. Cough and angioneurotic edema associated with angiotensin-converting enzyme inhibitor therapy. A review of the literature and pathophysiology. Annals of internal medicine. 1992; 117(3):234-42. [pubmed]
• Bangalore S, Kumar S, Messerli FH. Angiotensin-converting enzyme inhibitor associated cough: deceptive information from the Physicians’ Desk Reference. The American journal of medicine. 2010; 123(11):1016-30. [pubmed]
• ONTARGET Investigators – Yusuf S, Teo KK, et al. Telmisartan, ramipril, or both in patients at high risk for vascular events. The New England journal of medicine. 2008; 358(15):1547-59. [pubmed]