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ACE inhibitors are among the most widely prescribed cardiovascular medicines.
Ramipril
Lisinopril
Perindopril
ACE inhibitors are, then, an important class of cardiovascular medicines that play a
significant clinical role in hypertension, heart disease and kidney complications.
To summarize:
ATII stimulates the release of aldosterone from the adrenal gland cortex.
In turn, aldosterone promotes reabsorption of sodium and chloride
ions, increasing water retention. During this process, potassium is also
excreted.
Vasoconstriction; increasing blood pressure.
ADH secretion from the posterior lobe of the pituitary gland, promoting water
retention from the collecting duct.
ACE inhibitors, by preventing production of ATII, has the following four effects:
Other potential side effects include headache, dizziness, fatigue and nausea.
Clinical considerations
When we talk about the clinical pharmacology of ACE inhibitors, we need to think about
the following factors:
That ACE inhibitors should be used with caution in patients with renal
impairment. Examples of renal impairment include renal artery stenosis and
acute kidney injury.
For chronic kidney disease lower doses should be used, and their effects
monitored closely.
ACE inhibitors are classified as pregnancy category D, meaning there is a
positive evidence of risk.
Due caution should be taken when prescribing ACE inhibitors with other
medicines that increase potassium levels – potassium supplements;
potassium-sparing diuretics such as amiloride and spironolactone.
Due to first-dose hypotension, care should be taken when ACE inhibitors are co-
prescribed with other hypotensive-producing agents. To reduce risk, first-dose
is preferentially administered before bed.
Risk of renal failure increases when ACE inhibitors are taken with NSAIDs.
ACE inhibitors can have a transformative impact on patients with hypertension, heart
disease and diabetic nephropathy. Their use continues to grow in an era where
cardiovascular disease and obesity become ever more prevalent.
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