Angiotensin-Converting Enzyme (ACE) Inhibitors
PREGNANCY CATEGORY D
Therapeutic actions
ACE inhibitors block ACE in the lungs from converting angiotensin I, activated when renin is released from the kidneys, to angiotensin II, a powerful vasoconstrictor. Blocking this conversion leads to decreased BP, decreased aldosterone secretion, a small increase in serum potassium levels, and sodium and fluid loss; increased prostaglandin synthesis also may be involved in the antihypertensive action.
Indications
Treatment of hypertension (alone or with thiazide-type diuretics)
Treatment of heart failure (used with diuretics and digitalis)
Treatment of stable patients within 24 hr of acute MI to improve survival (lisinopril)
Reduction in risk of MI, stroke, and death from CV causes (ramipril)
Treatment of left ventricular dysfunction post-MI (captopril, trandolapril)
Treatment of asymptomatic left ventricular dysfunction (enalapril)
Treatment of diabetic nephropathy (captopril)
Unlabeled uses: Renovascular hypertension, nondiabetic nephropathy, migraine prophylaxis, stroke prevention, heart failure, high risk of CAD, diabetes, chronic renal disease, scleroderma renal crisis
Contraindications and Cautions
Contraindicated with allergy to the drug, impaired renal function, heart failure, salt or volume depletion, lactation, pregnancy, history of angioedema, bilateral renal artery stenosis.
Adverse Effects
CNS: Dizziness, headache, fatigue
CV: Tachycardia, angina pectoris, MI, Raynaud’s syndrome, heart failure, hypotension in salt- or volume-depleted patients
Dermatologic: Rash, pruritus, alopecia, pemphigoid-like reaction, scalded mouth sensation, exfoliative dermatitis, photosensitivity
GI: Gastric irritation, aphthous ulcers, peptic ulcers, dysgeusia, cholestatic jaundice, hepatocellular injury, anorexia, constipation
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