ACE inhibitors are drugs from the group of antihypertensive drugs. They are used to treat high blood pressure, chronic heart failure and as prophylaxis against strokes and heart attacks. They develop their effect by inhibiting certain enzymes that produce angiotensin II from angiotensin I.
This enzyme is called angiotensin converting enzyme, from which the name ACE inhibitor is derived. The ACE enzyme is responsible in the body for narrowing blood vessels. If this mechanism is switched off by an ACE inhibitor, vasodilation (dilatation) occurs.
This dilatation leads to a decrease in the tone of the blood vessels and thus to a drop in blood pressure. In addition to the blood pressure-lowering effect through dilatation of the vessels, ACE leads to a reduction in the release of aldosterone (see: mineral corticoids) from the adrenal cortex. Aldosterone is a steroid hormone which leads to an increased reabsorption of water and sodium in the kidney.
A reabsorption of water leads to an increase in the volume of blood in the blood vessels, which increases blood pressure. By administering ACE inhibitors, this mechanism is switched off and blood pressure drops. Another important function of ACE is the inactivation of bradykinin-degrading kinases (a type of enzyme).
Bradykinin is a vasodilating tissue hormone. By inhibiting the kinase mentioned above, bradykinin therefore remains present longer. The most important active ingredients of ACE inhibitors are captopril, enalapril, lisinopril and ramipril.
Side effects of ACE inhibitors
Side effects that all ACE inhibitors can cause are Caution is especially important if taken during pregnancy. One side effect caused by taking ACE inhibitors is the so-called ACE inhibitor cough. This is a dry cough that can occur in 5-35% of patients.
Asthma attacks and shortness of breath can also occur. This side effect is caused by the inhibition of the bradykinin-degrading kinases which leads to an overactivation of the bradykinins. Bradykinin, which causes contraction at the bronchial tubes, can thus lead to bronchospasms and trigger a dry cough.
The attack of ACE inhibitors on kidney function, in the form of water retention, can lead to acute kidney failure. This side effect is mainly observed in patients with kidney failure. Hyperkalemia occurs in less than 10% of patients.
It occurs mainly in patients with renal insufficiency. It is also a risk factor for patients who are taking potassium-sparing diuretics or NSAIDs at the same time or who suffer from heart failure. In general, patients with renal failure or heart failure should be more cautious when taking ACE inhibitors.
Acute kidney failure may occur due to the attack of ACE inhibitors on kidney function, in the form of water retention. This side effect is mainly observed in patients with kidney failure. Hyperkalemia occurs in less than 10% of patients.
It occurs mainly in patients with renal insufficiency. It is also a risk factor for patients who are taking potassium-sparing diuretics or NSAIDs at the same time or who suffer from heart failure. In general, patients with renal failure or heart failure should be more cautious when taking ACE inhibitors.
- Hypotension, due to a too strong blood pressure reduction,
- Hyperkalemia due to increased sodium excretion and
- Acute kidney failure.
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