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Angiotensin-Converting Enzyme (ACE) Inhibitors

Mohommed Essop-Adam
Reviewed by Mohommed Essop-AdamReviewed on 30.10.2023 | 3 minutes read
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ACE inhibitors, exclusively available through medical prescription, encompass a class of pharmacological agents that include ramipril, enalapril, lisinopril, perindopril, quinapril, fosinopril, imidapril, captopril, and trandolapril. Primarily recommended for adults dealing with high blood pressure (hypertension) and heart failure, certain ACE inhibitors can also cater to paediatric patients. These medications are available in various formulations, including tablets, capsules, and oral liquids.

Mechanism of Action

ACE inhibitors operate by effectively impeding the activity of an enzyme present within the body known as angiotensin-converting enzyme (ACE). Enzymes, acting as catalysts, accelerate biochemical reactions within the body. In particular, angiotensin-converting enzymes contribute to the synthesis of a hormone called angiotensin II. By reducing the production of angiotensin II, ACE inhibitors facilitate vasodilation (widening of blood vessels) and diminish the fluid volume in the bloodstream. Consequently, these medications effectively lower blood pressure, aid in the management of heart failure, and enhance the heart's ability to pump blood throughout the body. By mitigating high blood pressure, the risk of heart attacks and strokes is substantially reduced. Additionally, ACE inhibitors demonstrate a protective effect on cardiac and renal function. As a result, they are often prescribed to individuals following a heart attack and those grappling with kidney disorders.

How to take ACE inhibitors?

The administration of ACE inhibitors necessitates adherence to precise instructions provided by your healthcare professional. Typically, treatment commences with a low dosage, which may be adjusted as deemed necessary. Generally, ACE inhibitors are consumed once or twice daily. With the exception of perindopril and imidapril, most ACE inhibitors can be taken with or without food. Perindopril should ideally be ingested 30 to 60 minutes before a meal, while imidapril is recommended 15 minutes prior to eating. It is important to note that ACE inhibitors may elicit an effect known as "first dose hypotension," resulting in a sudden decrease in blood pressure following initial administration. This may manifest as dizziness, lightheadedness, or fainting. To mitigate this effect, your healthcare provider may advise taking the first dose before bedtime. Subsequent doses can be adjusted to suit your convenience, ideally maintaining a consistent daily schedule.

Who should avoid ACE inhibitors?

Before initiating ACE inhibitor therapy and throughout the course of treatment, your physician will conduct tests to assess kidney function, blood pressure levels, and electrolyte balance in your bloodstream. This monitoring is crucial to ensure optimal efficacy and safety.

Certain individuals should exercise caution and avoid ACE inhibitors in specific circumstances. If you are allergic to any of the ingredients in the medication or have experienced a previous allergic reaction to an ACE inhibitor, it is contraindicated. Similarly, individuals who have previously encountered a severe allergic reaction known as angioedema should refrain from ACE inhibitors. If you are currently taking a blood pressure-lowering medication called aliskiren and have diabetes or kidney problems, ACE inhibitors should be avoided. It is important to note that, in general, ACE inhibitors are not recommended during pregnancy or breastfeeding due to potential risks.

Potential Side Effects

As with any medication, ACE inhibitors may cause side effects in some individuals. Should you experience bothersome side effects, it is recommended to consult your healthcare professional or pharmacist. Common side effects associated with ACE inhibitors include headaches, persistent dry cough, drowsiness, stomach ache, and nausea. As ACE inhibitors lower your blood pressure, sometimes they can make you feel dizzy and lightheaded. Usually, this occurs when you stand up after sitting or lying down (postural hypotension). If you feel dizzy or lightheaded, you should avoid drinking alcohol because it can worsen these side effects.

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Mohommed Essop-Adam
Reviewed by Mohommed Essop-Adam
Reviewed on 30.10.2023
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