Angiotensin Converting Enzyme (ACE) Inhibitors

ACE inhibitors are used for a variety of indications including hypertension, heart failure, diabetic nephropathy, and post myocardial infarction. ACE inhibitors work by preventing the conversion of angiotensin I to angiotensin II in the renin-angiotensin-aldosterone system. ACE inhibitors result in less sodium and water retention from reduced aldosterone levels.  Reduction of angiotensin II levels decreases vasoconstriction, which results in reduced preload and afterload.  Bradykinin levels rise with ACE inhibitors. Bradykinin is a vasodilator and also contributes to cough and angioedema associated with ACE inhibitors.

Class Drugs

• Benazepril

• Captopril

• Enalapril

• Fosinopril

• Lisinopril

• Moexipril

• Quinapril

• Perindopril

• Ramipril

• Trandolapril

Class Mechanism of Action

• Blocks ACE (angiotensin converting enzyme), decreasing angiotensin II levels

• Increases bradykinin levels resulting in vasodilation

Class Applications

Hypertension

• Reduces preload and afterload by causing vasodilation (reduced vasoconstriction) and dilation of arterioles

• Decreases aldosterone secretion, resulting in decreased sodium and water retention

Heart Failure

• Decreased preload and afterload secondary to vasodilation (muscle arterioles and venous system), resulting in increased cardiac output

• Decreases aldosterone levels, resulting in decreased sodium and water retention

• Improves patient survival in heart failure

Diabetic Nephropathy

• Causes mild initial increase in creatinine level, but over time preserves renal function

• Decreases albuminuria

• Likely from dilation of efferent arterioles, resulting in decreased intraglomerular pressures

Post Myocardial Infarction

• Blood pressure reduction

• Prevention of remodeling after myocardial infarction

• Decreases LVH

Class Adverse Effects

• Angioedema, cough

Thought to result from increased bradykinin production

• Substance P levels also increase, resulting in increased cough

• Teratogenic, contraindicated in pregnancy

• Hyperkalemia

• Rash

Drug Table

Drug Name	Application	Comments	Image
Benazepril			"Benz" "Quill"
Captopril			"Captain" "Quill"
Enalapril			"Enamel Paint" "Quill"
Fosinopril			"Jodie Foster" "Quill"
Lisinopril			"Listerine" "Quill"
Moexipril			"Moe" "Exxon" "Quill"
Quinapril			"Equinox" "Quill"
Perindopril			"Pear" "In" "Quill"
Ramipril			"Ram" "Quill"
Trandolapril			"Train" "Quill"