Sunday 13 December 2009, 23:02

ACE inhibitors

An overview on effectiveness, safety and adverse effects of ACE inhibitors

ACE inhibitors

ACE inhibitors are medicines that slow or inhibit the activity of angiotensin converting enzyme (ACE), which is responsible for the synthesis of angiotensin II and the inactivation of bradykinin.


Angiotensin II is a blood oligopeptide whose activity affects a variety of body’s organs and systems (cardiovascular system, CNS, adrenal cortex and kidneys). In the cardiovascular system it causes artery and vein vasoconstriction, increases blood pressure and stimulates cardiac cells growth during hypertrophy. The neural, adrenal and renal effects of angiotensin II are all directed to maintain body fluid-electrolyte balance: it increases thirst sensation, stimulates the adrenal cortex to release aldosterone (responsible for renal sodium retention and renal potassium excretion) and stimulates the kidneys to reabsorb sodium.


With ACE inhibitors use, the synthesis of angiotensin II is reduced and its effects are prevented. The overall results from using ACE inhibitors are therefore a decrease in blood pressure and cardiac workload and an increase in cardiac output and natriuresis.


ACE inhibitors are used primarly for the treatment of hypertension and congestive heart failure. Actually ACE inhibitors are not the initial best choice for many cases of hypertension, especially for patients with high blood pressure but who don’t have diabetes or other heart disorders. In these cases, generic diuretics are a better first choice, given alone or in combination with ACE inhibitors.


However ACE inhibitors are often a first choice for the treatment of congestive heart failure, myocardial infarction, diabetes and diabetic kidney disease. In particular ACE inhibitors have shown to effectively slow the progression of heart failure and prevent heart attacks. The conditions listed above may also be treated by a combination of ACE inhibitors and beta-blockers.


ACE inhibitors effectiveness is high. Current evidence shows that they effectively improve quality of life and prevent heart attacks in patients affected by high blood pressure, congestive heart failure and other heart diseases, diabetes and diabetic kidney disease. However only few studies have compared ACE inhibitors to each other in terms of effectiveness and safety.


ACE inhibitors are generally safe drugs. Their common side effect is dry cough. Other side effects occur less commonly. They include excessively low blood pressure, dizziness, headache, high blood potassium and nausea. All ACE inhibitors may cause birth defects and should not be used by pregnant women.


By Chiara De Carli

Category: Pharmacy

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