Angiotensin-converting enzyme inhibitors (ACE inhibitors)

Angiotensin-converting enzyme inhibitors (ACE inhibitors)

How do ACE inhibitors work?

The mechanism of action of ACE inhibitors is complex. Drugs of this group violate (inhibit) the formation of aldosterone and angiotensin, which have a powerful Pressor (increase in blood PRESSURE) effect. These drugs prevent narrowing of blood vessels and as a result reduce blood pressure. In addition, ACE inhibitors have a beneficial effect on the heart, kidneys, metabolism of fats and carbohydrates.

What are the different types of ACE inhibitors?

In the 70s, the first drug of this group was obtained-captopril. Its disadvantages include primarily a short action, so the drug has to be taken 2-3 times a day. Currently, captopril is used mainly for the relief of a hypertensive crisis (1 tablet of 25 mg under the tongue).

In our country, one of the first long – acting ACE inhibitors, enalapril, was widely used. This drug is well studied, as are new ACE inhibitors: lisinopril, perindopril, ramipril, fosinopril. They can be taken even 1 time a day, dosages vary, so the doctor chooses both the frequency of administration and the dose of an ACE inhibitor.

What are ACE inhibitors good for?

ACE inhibitors reduce blood pressure well, and rarely cause adverse reactions. In addition, they have a positive effect on the state of the heart – reduce hypertrophy (weight gain) of the heart muscle, reduce the tendency to heart rhythm disorders. ACE inhibitors have a positive effect on fat and carbohydrate metabolism, so they are often prescribed in combination with hypertension and metabolic disorders (obesity, diabetes). These drugs have a protective effect on the kidneys. We have already discussed with you the problems of improving the condition of vital organs (organoprotection) in the treatment of hypertension. ACE inhibitors have organoprotective effects.

In which cases does the doctor prescribe ACE inhibitors?

In addition to the treatment of hypertension, ACE inhibitors have advantages in heart failure, in patients who have suffered a myocardial infarction. In the combination of hypertension with renal failure, diabetic kidney disease, ACE inhibitors are the drugs of choice.

When can I not prescribe ACE inhibitors?

ACE inhibitors are strictly forbidden to take pregnant women. They should not be taken with an increased content of potassium in the blood (hyperkalemia), narrowing (stenosis) of the renal arteries.

Simultaneous administration of potassium preparations, potassium-sparing diuretics can lead to an increase in the content of potassium in the blood (hyperkalemia). If the doctor considers it necessary to prescribe such a combination of drugs, regular monitoring of the level of potassium in the blood is required.

Be sure to tell your doctor:

• Whether you have taken ACE inhibitors before, how you reacted to them, whether you were bothered by a dry cough while taking ACE inhibitors.

• You are pregnant or want to have a baby soon, what contraceptives you use.

How should ACE inhibitors be taken?

Most ACE inhibitors are taken 1-2 times a day (with the exception of captopril, which is taken 3-4 times a day) before meals with a small amount of water. Long-acting ACE inhibitors are recommended to be taken once a day in the evening at the same time.

What side effects are possible when taking ACE inhibitors?

Adverse reactions are varied and occur with different frequency. Most often (in 6-12% of cases) there is a dry nasal cough or a feeling of “tickling” in the larynx and pharynx. Dry cough often appears when taking captopril. Modern ACE inhibitors rarely cause coughing. Sometimes after taking the first tablet, an allergic reaction of various severity occurs – from skin rashes to swelling of the face, lips, hoarseness and swallowing disorders. If you suddenly feel that it is difficult to breathe and swallow, notice that your face, eyes, and lips are swollen, postpone taking the drug and immediately consult a doctor!

When taking the first dose of the drug (especially captopril and enalapril), there may be a sharp decrease in blood pressure (“hypotension of the first dose”). Very rarely, when taking ACE inhibitors, there are blood changes, signs of chronic rhinitis, frequent night urination.

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