ASH SPECIAL ISSUE REVIEW PAPER
Angiotensin-Converting Enzyme Inhibitors
Article first published online: 18 JUL 2011
© 2011 Wiley Periodicals, Inc.
The Journal of Clinical Hypertension
Volume 13, Issue 9, pages 667–675, September 2011
How to Cite
Izzo, Jr , J. L. and Weir, M. R. (2011), Angiotensin-Converting Enzyme Inhibitors. The Journal of Clinical Hypertension, 13: 667–675. doi: 10.1111/j.1751-7176.2011.00508.x
- Issue published online: 6 SEP 2011
- Article first published online: 18 JUL 2011
J Clin Hypertens (Greenwich). 2011;13:667–675. ©2011 Wiley Periodicals, Inc.
Key Points and Recommendations
- •In addition to hypertension, angiotensin-converting enzyme inhibitors are indicated for treatment of patients at high risk for coronary artery disease, after myocardial infarction, with dilated cardiomypathy, or with chronic kidney disease.
- •The most familiar angiotensin-converting enzyme subtype, angiotensin-converting enzyme-1 (kininase II), cleaves the vasoconstrictor octapeptide angiotensin II from its inactive decapeptide precursor, angiotensin I, while simultaneously inactivating the vasodilator bradykinin.
- •Biochemical pathways within and around the renin-angiotensin system are highly species-specific; there is little evidence that “angiotensin-converting enzyme bypass pathways” have major clinical implications in humans.
- •Dietary sodium loading can diminish or abolish the antihypertensive effect of an angiotensin-converting enzyme inhibitor, while salt restriction or concomitant diuretic therapy enhances it.
- •Dose-response curves with angiotensin-converting enzyme inhibitors are quite flat but their peak effects vary in different individuals.
- •Increased serum creatinine (decreased glomerular filtration rate) during acute or chronic angiotensin-converting enzyme inhibition identifies individuals likely to experience long-term renal protective benefits.
- •Angiotensin-converting enzyme inhibitors are contraindicated in pregnancy due to fetal toxicity.
- •Use of angiotensin-converting enzymes can be limited by idiosyncratic reactions (cough or angioedema), hyperkalemia (usually in cardiac or renal failure or with combined renin-angiotensin blockade) or hypotension (usually with severe volume-depletion or cardiac failure).