ACE Inhibitor-Related Angioedema: Can Angiotensin-Receptor Blockers Be Safely Used?

Authors

  • Domenic A. Sica MD,

    1. From the Section of Clinical Pharmacology and Hypertension, Division of Nephrology, Medical College of Virginia of Virginia Commonwealth University, Richmond, VA1 and the Department of Preventive Medicine, Rush Presbyterian-St. Luke's Medical Center, Chicago, IL2
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  • and 1 Henry R. Black MD 2

    1. From the Section of Clinical Pharmacology and Hypertension, Division of Nephrology, Medical College of Virginia of Virginia Commonwealth University, Richmond, VA1 and the Department of Preventive Medicine, Rush Presbyterian-St. Luke's Medical Center, Chicago, IL2
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Domenic A. Sica, MD, Professor of Medicine and
Pharmacology; Chairman, Section of Clinical
Pharmacology and Hypertension, Division of
Nephrology, Medical College of Virginia of Virginia
Commonwealth University, Box 980160, Richmond,
VA 23298-0160dsica@hsc.vcu.edu

Abstract

Angioedema is a well-recognized side effect of angiotensin-converting enzyme (ACE) inhibitor therapy. Angioedema can also be seen with angiotensin receptor blocker therapy but much less frequently than is the case with ACE inhibitors. For unclear reasons, ACE inhibitor-related angioedema occurs more commonly in black patients. Angioedema can be life threatening but more times than not its occurrence can be managed with conservative treatment measures including discontinuation of the medication and/or administration of an antihistamine. Occasionally, epinephrine and/or steroid therapy may be warranted. In a patient having experienced ACE inhibitor-related angioedema, angiotensin receptor blockers should be used cautiously if at all. If angiotensin receptor blocker therapy is being considered in a patient with prior ACE inhibitor-related angioedema there should be some justification for the use. Such justification might include the presence of heart failure or proteinuric nephropathic states among other considerations.

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