aceis
ACE inhibitors
introduction:
ACE is an enzyme that converts:
ACE is found in endothelial cells lining all blood vessels as well as in the lung, brain, kidney, adrenals, GIT, & reproductive system;
ACE inhibition thus:
clinical uses:
essential hypertension:
ACE inhib. are effective, well tolerated in most types & grades of severity of hypertension & in mild-severe essential HT are as potent & effective single agent Rx as beta-blockers or diuretics;
Their efficacy can be improved by combination with a low Na diet, or a K-losing diuretic or Ca antagonist.
They are ideal in the elderly except care if renal impairment or extensive vascular disease;
accelerated/malignant hypertension:
renovascular hypertension:
hypertension assoc. with renal disease & ESRF:
heart failure:
ACE inhib. are the single most important advance in Rx CCF since diuretics.
They improve cardiovasc. haemodynamics (as above) resulting in:
improved symptoms;
incr. exercise tolerance;
improved heart size;
incr. LV ejection fraction;
improves cardiac remodelling after AMI;
decr. ventricular ectopic beats & arrhythmias:
prolongs life reducing overall mortality in severe CCF by 27%;
ACE inhib. is usually combined with K-losing diuretics ± digoxin;
combinational therapy:
contraindications:
History of HS reaction to ACE inhib.
History of angioneurotic oedema assoc. with ACE inhib.;
Pregnancy (category D) / lactation
special precautions:
Impaired renal function:
bilat. renal A stenosis or stenosis lone kidney → reversible ARF;
most ACE inhib. are renally excreted;
occasional incr. urea/CRN assoc. with ACE inhib. may indicate decr. dose needed;
Hyperkalaemia:
Impaired liver function:
General Anaesthesia:
Persistent cough esp. females & on lying down may need decr. dose or cessation;
Safety not established in children;
Best to withdraw drugs that raise plasma renin levels before commencing ACE inhibitors, for example: diuretics, potent vasodilators;
drug interactions:
adverse reactions:
aceis.txt · Last modified: 2020/03/25 23:25 (external edit)