Clinical uses of angiotensin converting enzyme inhibitors (ACEI) – Diabetic nephropathy: Prevent or delay end stage renal disease in type I as well as type II diabetics. Albuminuria remains stable in those treated with ACEI, but aggravates in untreated diabetics. – Hypertension - advantages: • Lack of postural hypotension, electrolyte disturbances, feeling of weakness and CNS effects. • Safety in asthmatics, diabetics and peripheral vascular disease patients. • Prevention of secondary hyperaldosteronism and K+ loss due to diuretics. • Renal blood flow is well maintained. • Reverse LVH. • No hyperuricemia and no deleterious effect on plasma lipid profile. • No rebound hypertension on withdrawal. – CHF : Congestive heart failure – MI : Myocardial infarction – Scleroderma Crisis : ACEI produces dramatic improvement and are life saving in this condition. Adverse effects of ACEI : (Captopril, Enalapril, Lisinopril, Perindopril and Ramipril) • Hypotension – An initial sharp fall in BP occurs specially in diuretic treated and CHF patients. • Hyperkalemia – Is an important risk in patients with impaired renal function and in those taking K+ sparing diuretics. NSAID or blockers. • Cough – Caused by inhibition of bradykinin/Substance P breakdown in the lungs of susceptible individuals. • Rashes, urticaria • Angioedema • Dysguesia (Altered taste sensation) • Fetopathic – Fetal growth retardation, hypoplasia of organs and fetal death may occurs if ACE inhibitors are given during later half of pregnancy but not teratogenic in the first half; must be stopped when the woman conceives. • Headache dizziness, nausea and bowel upset. • Granulocytopenia and proteinuria are rare. • Acute renal failure – Precipitated by ACEI in patient with bilateral renal artery stenosis and single function kidney due to dilatation of efferent arterioles and fall in GF pressure; contraindicated in such patients.
Clinical uses of angiotensin converting enzyme inhibitors (ACEI)
Diabetic nephropathy: Prevent or delay end stage renal disease in
type I as well as type II diabetics. Albuminuria remains stable in
those treated with ACEI, but aggravates in untreated diabetics.
Hypertension - advantages: Lack of postural hypotension,
electrolyte disturbances, feeling of weakness and CNS effects.
Safety in asthmatics, diabetics and peripheral vascular disease
patients. Prevention of secondary hyperaldosteronism and K+ loss
due to diuretics. Renal blood flow is well maintained. Reverse LVH.
No hyperuricemia and no deleterious effect on plasma lipid profile.
No rebound hypertension on withdrawal. CHF : Congestive heart
failure MI : Myocardial infarction Scleroderma Crisis : ACEI
produces dramatic improvement and are life saving in this
condition. Adverse effects of ACEI : (Captopril, Enalapril,
Lisinopril, Perindopril and Ramipril) Hypotension An initial sharp
fall in BP occurs specially in diuretic treated and CHF patients.
Hyperkalemia Is an important risk in patients with impaired renal
function and in those taking K+ sparing
diuretics. NSAID or blockers. Cough Caused by inhibition of
bradykinin/Substance P breakdown in the lungs of susceptible
individuals. Rashes, urticaria Angioedema Dysguesia (Altered taste
sensation) Fetopathic Fetal growth retardation, hypoplasia of
organs and fetal death may occurs if ACE inhibitors are given
during later half of pregnancy but not teratogenic in the first
half; must be stopped when the woman conceives. Headache dizziness,
nausea and bowel upset. Granulocytopenia and proteinuria are rare.
Acute renal failure Precipitated by ACEI in patient with bilateral
renal artery stenosis and single function kidney due to dilatation
of efferent arterioles and fall in GF pressure; contraindicated in
such patients.
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