hypertension treatment with ace inhibitors why not

In a review published in the Journal of the American College of Cardiology, four experts stated there is no reason to use ACE inhibitors

to treat hypertension when angiotensin receptor blockers can be used instead.

Full Answer

What are the most common side effects of ACE inhibitors?

The most serious, but rare, side effects of ACE inhibitors are:

• Kidney failure
• Allergic reactions
• Pancreatitis
• Liver dysfunction
• A decrease in white blood cells
• Swelling of tissues ( angioedema ).

How do ACE inhibitors work to lower blood pressure?

Those include:

• They work. ACE inhibitors have the support of extensive scientific research showing they’re effective.
• They’re preventive. One of the most important effects of ACE inhibitors is not just that they can treat existing problems. ...
• They often combine well with others. ...
• They’re safe. ...

What are the most common ACE inhibitors?

The following is a list of the ACE inhibitors that are available in the United States:

• benazepril ( Lotensin, Lotensin Hct),
• captopril ( Capoten ),
• enalapril (Vasotec),
• fosinopril ( Monopril ),
• lisinopril ( Prinivil, Zestril ),
• moexipril (Univasc)
• perindopril (Aceon),
• quinapril ( Accupril ),

What medications are ACE inhibitor?

Examples of ACE inhibitors include:

• Benazepril (Lotensin)
• Captopril
• Enalapril (Vasotec)
• Fosinopril
• Lisinopril (Prinivil, Zestril)
• Moexipril
• Perindopril
• Quinapril (Accupril)
• Ramipril (Altace)
• Trandolapril

Why are ACE inhibitors contraindicated in hypertension?

ACE inhibitors prevent an enzyme in the body from producing angiotensin II, a substance that narrows blood vessels. This narrowing can cause high blood pressure and forces the heart to work harder. Angiotensin II also releases hormones that raise blood pressure.

Why should ACE inhibitors not be taken with ARBs?

ACE inhibitors should not be combined with ARBs because such combinations increase the risk of hypotension, hyperkalemia, and renal impairment.

Why are ACE inhibitors contraindicated?

Contraindications to ACEI use include hyperkalemia (>5.5 mmol/L), renal artery stenosis, pregnancy (ACEI or Australian Drug Evaluation Committee [ADEC] pregnancy category D), or prior adverse reaction to an ACEI including angioedema.

When Should ACE inhibitors not be used?

The following are people who shouldn't take ACE inhibitors: Pregnant women. An ACE inhibitor might hurt the baby during the last six months of pregnancy. If you were already taking an ACE inhibitor and stop taking it during the first three months of pregnancy, the risk to your baby is very low.

Can you give ACE inhibitor and ARB together?

However, we maintain that based on the data from ValHeFT and CHARM-Added, ARBs can be safely combined with ACE-inhibitors in patients with heart failure without serious risk of renal failure or hyperkalemia and regardless of background beta blocker therapy.

Why are ACE inhibitors first-line for hypertension?

Introduction. ACE (angiotensin-converting enzyme) inhibitors and angiotensin receptor blockers (ARBs) effectively lower blood pressure (BP) through inhibition of the renin-angiotensin system and are equally recommended as first-line medications in the treatment of hypertension.

What is the most common adverse effect of an ACE inhibitor?

ACE inhibitors block the breakdown of bradykinin, causing levels of this protein to rise and blood vessels to widen (vasodilation). Increased bradykinin levels are also responsible for the most common side effect of ACE inhibitor treatment; a dry cough.

Why are ACE inhibitors cardioprotective?

ACE inhibitors reportedly limit infarct size, prevent ventricular remodelling and, more importantly, stabilize the electrical activity of the reperfused heart and prevent the occurrence of reperfusion arrhythmias.

What should you check before giving an ACE inhibitor?

When you start on an ACE inhibitor, you will need blood tests to monitor your kidney function and potassium levels. Be aware: If you take an ACE inhibitor, keep a written log of your heart rate (pulse) and blood pressure. Track your heart rate by taking your pulse daily.

In which of the following scenarios ACE inhibitors is contraindicated?

Patients with aortic valve stenosis: ACE inhibitors reduce afterload and lead to severe hypotension, so these patients should not receive ACE inhibitors. Patient with hypovolemia: ACE inhibitors can worsen dehydration and hypovolemia, so these patients should not receive treatment with ACE inhibitors.

Why ACE inhibitors are contraindicated in bilateral renal artery stenosis?

Angiotensin-converting enzyme inhibitors (ACEIs) are contraindicated in patients with bilateral renal artery stenosis due to risk of azotemia resulting from preferential efferent arteriolar vasodilation in the renal glomerulus due to inhibition of angiotensin II.

Why ACE inhibitors are contraindicated in CKD?

The major safety concerns with ACE-inhibitor or ARB therapy in the CKD patient are hyperkalemia and a rapid decline in GFR. These drugs should not be used in patients with baseline hyperkalemia.

Is enalapril better than fosinopril?

Many of these trials are done in comparison to enalapril, which is known to have a somewhat high side-effect profile, especially with regard to cough, where as drugs like fosinopril have a lower side-effect profile and might be better tolerated.

Do Asians have a high incidence of ACE inhibitor-induced cough?

For example, Asians have a high incidence of ACE inhibitor-induced cough. If the message that ACE inhibitors should be used first is propagated, many patients may become noncompliant. Now is a good time to debate if that approach is valid.” – by Erik Swain. For more information:

Do angiotensin receptor blockers reduce strokes?

Most studies of the drugs in patients with diabetes have shown no difference in benefit, but one found angiotensin receptor blockers were better at reducing events than ACE inhibitors regardless of diabetes history, Messerli and colleagues wrote. The drugs have shown no difference in stroke rates in patients with cerebrovascular disease, ...

Can angiotensin blockers reduce CV?

Among patients with CAD, angiotensin receptor blockers “reduce CV events, including the risk of MI, as effectively but more safely ...

Do ACE inhibitors cause strokes?

The drugs have shown no difference in stroke rates in patients with cerebrovascular disease, according to the researchers. However, the authors wrote, ACE inhibitors have a worse adverse effect profile than angiotensin receptor blockers. A dry, irritating cough is the most common adverse effect of ACE inhibitors and particularly pronounced in Asian ...

Do ACE inhibitors cause higher mortality rates?

Most studies of the drugs in patients with CKD have shown no difference in benefit, but one study of more than 14,000 patients with CKD found that mortality rates were higher in those using ACE inhibitors than in those using angiotensin receptor blockers, according to the researchers.

Can ACE inhibitors cause coughing?

A dry, irritating cough is the most common adverse effect of ACE inhibitors and particularly pronounced in Asian patients, they wrote. Angioedema, a more serious adverse effect that is sometimes fatal, is more common in those using ACE inhibitors than in those using angiotensin receptor blockers. Although angioedema is rare, “use ...

Is ACE a good first treatment for hypertension?

ACE Inhibitors Aren’t Always Best Choice for First Treatment of Hypertension. By staff. Los Angeles— Angiotensin-converting enzyme (ACE) inhibitors might be widely prescribed for initial treatment of extremely high blood pressure, but a new study suggests that doesn’t mean that the drug class is the best choice.

Is ACE inhibitor effective for hypertension?

The authors point out that ACE inhibitors, the most popular first-line treatment for hypertension, are not as effective and cause more side effects compared with thiazide diuretics.

Why are ACE inhibitors effective?

ACE inhibitors show efficacy in treatment due to the overall reduction of mortality in multiple disease states. There is evidence of mortality benefit in patients with hypertension, heart failure, Acute MI, and diabetes mellitus. [2][3][4]

What is ACE inhibitor?

ACE Inhibitors - StatPearls - NCBI Bookshelf. ACE inhibitors are a medication class used to treat and manage hypertension, which is a significant risk factor for coronary disease, heart failure, stroke, and a host of other cardiovascular conditions. Most cases are primary and not attributable to any specific etiology.

What is the mechanism of action of angiotensin converting enzyme?

The angiotensin-converting-enzyme is involved in the renin-angiotensin-aldosterone system (RAAS; media item 1) and stimulates the conversion of angiotensin I to angiotensin II. ACE inhibitors are competitive inhibitors of ACE, which prevent the conversion of angiotensin I to angiotensin II.

How long does it take for a dry cough to go away after ACE?

Dry Cough: Commonly, patients on ACE inhibitors have reported dry cough between the one week of initiation up to six months. Some sources cite up to one year after initiation. Discontinuing therapy usually resolves the cough 1 to 4 days after, but it can be prolonged up to a month.[12]  The concern for dry cough with therapy initiation is a decrease in medication adherence. Additionally, there is an increased propensity to develop bronchospasm in these patients. [13]

How many groups are there in ACE inhibitors?

Depending on the Chemical Structure, ACE Inhibitors are Classified into Three Groups:

What is the BP of a patient with daytime BP out of the office?

Patients with daytime BP out of the office at greater than 135 mmHg systolic or greater than 85 mmHg diastolic; this is substitutable with office blood pressure readings of over 140/90 mmHg

Can ACE inhibitors be used for CAD?

Patients with coronary artery disease (CAD) and HTN: ACE inhibitors are recommended as part of a regimen in patients with HTN and chronic stable angina if there is a history of left ventricular dysfunction, diabetes mellitus, or CKD. 5.

What is the effect of ACE inhibitors on blood pressure?

ACE inhibitors block an enzyme that triggers the production of angiotensin, which therefore reduces blood pressure.

Why are there disagreements between studies as to whether ACE inhibitors should be the preferred form of treatment?

In addition, disagreement exists between studies as to whether ACE inhibitors, due to their longer history of use , should be the preferred form of treatment.

How many participants in the ACE study?

The large-scale study focused on over 3 million participants with no history of heart disease or stroke who began high blood pressure treatment using ACE inhibitors or ARBs.

Do ACE inhibitors cause swelling?

Results from the study also show that people taking ACE inhibitors were three times more likely to develop fluid accumulation, swelling of the deeper layers of the skin and mucous membranes, and a sudden inflammation of the pancreas.

Who mentioned patients who may have other preexisting medical conditions that need to be treated along with hypertension?

Dr. Tomey mentioned patients who may have other preexisting medical conditions that need to be treated along with hypertension. He concluded: “We need to be sensitive to the fact that certain specific groups of patients may yet get superior benefits from one drug over the other.”

Is ACE a first line medication?

ACE inhibitors and ARBs are equally recommended as first-line medications in the treatment of high blood pressure.

What are some examples of ACE inhibitors?

There are several ACE inhibitors available. Examples include enalapril (Vasotec, Epaned), lisinopril (Prinivil, Zestril, Qbrelis) and ramipril (Altace). Angiotensin II receptor blockers (ARBs). These drugs block the action of angiotensin, a chemical in your body that narrows your arteries and veins.

How to control high blood pressure?

Try these lifestyle changes to help lower and control your blood pressure. Eat a healthy diet with plenty of fruits and vegetables and reduce the amount of sodium in your diet. ...

What are some examples of beta blockers?

Examples of beta blockers include metoprolol (Lopressor, Toprol-XL), nadolol (Corgard) and atenolol (Tenormin). Renin inhibitors. Renin is a substance produced by your kidneys that triggers a series of steps that increases blood pressure.

What is the best medicine for a relaxed heart?

Alpha blockers. Alpha blockers prevent the hormone norepinephrine (noradrenaline) from tightening the muscles in the walls of smaller arteries and veins, which causes the vessels to remain open and relaxed. Commonly prescribed alpha blockers include doxazosin (Cardura), prazosin (Minipress) and terazosin.

What are some examples of calcium channel blockers?

Examples of calcium channel blockers include amlodipine (Norvasc), diltiazem (Cardizem, Tiazac, others), nifedipine (Adalat CC, Procardia) and verapamil (Verelan, Calan). Beta blockers. These drugs work by blocking the effects of the hormone epinephrine, also known as adrenaline.

What is the best medication to relax the arteries?

Calcium channel blockers. These medications prevent calcium from entering the cells of your heart and arteries, allowing your arteries to relax and open.

What to do if lifestyle changes aren't enough to control blood pressure?

If making lifestyle changes isn't enough to control your blood pressure, your doctor will likely prescribe blood pressure medication. You may be given one or more of these medications:

How does ACE inhibitor affect blood pressure?

ACE inhibitors decrease the blood pressure by inhibiting the angiotensin-converting enzyme; this causes a decline in the production of angiotensin II and increases the bradykinin level by inhibiting its degeneration, which leads to vasodilation. [31]

How does thiazide affect the proximal tubule?

[29] Thiazides can have a small effect on the proximal tube by impairing sodium transport, but the main action is on the distal tubule. Thiazides cause initial volume depletion associated with decreased cardiac output, which recovers within 6 to 8 weeks of starting the treatment in a reverse autoregulation mechanism while the blood pressure remains controlled; thiazide diuretics can acutely activate the renin-angiotensin system and cause systemic vascular resistance, which prevents a good response to the diuretic treatment, this increase in renin-angiotensin activity may resolve with chronic thiazide treatment, the addition of an ACE inhibitor or ARB can enhance the blood pressure control. Also, the thiazide-type diuretics have a modest vasodilation effect, although the mechanism is still unclear.

What is the HTN stage?

The 2017 American College of Cardiology (ACC) and American Heart Association (AHA) definition of HTN stages is: Normal blood pressure (BP): systolic BP is less than 120, and diastolic BP is less than 80. Elevated BP: systolic BP 120 to 130 ...

Which is better, chlorthalidone or doxazosin mesylate?

Chlorthalidone, when compared with doxazosin mesylate, was better in preventing cardiovascular disease, when compared with lisinopril was found to be better in preventing cardiovascular disease, including strokes and heart failure incidence, and when compared with amlodipine was better in preventing heart failure.

What is the target BP for kidney disease?

In patients with chronic kidney disease, the target BP is 130/80. For patients with type 2 diabetes mellitus (T2DM), it is recommended to start on antihypertensive medications if BP is more than 130/80 with a goal of BP lower than 130/80.

Does hydrochlorothiazide lower blood pressure?

Switching to chlorthalidone from hydrochlorothiazide decreases systolic blood pressure by 7 to 8 mm Hg.

Is chlorthalidone better than hydrochlorothiazide?

They are better at decreasing the risk of cardiovascular disease comparing to hydrochlorothiazide. [4][5] Chlorthalidone is the drug of choice to start as monotherapy for hypertension. Studies show it to be the best diuretic to control blood pressure and to prevent mortality and morbidity.

Why are ACEIs used for hypertension?

ACEIs are widely used to treat hypertension because they are effective, have relatively few side effects and in reduce the complications of hypertension such as heart attacks and strokes. They have a special use in patients with diabetes mellitus who have protein the urine (“diabetic nephropathy”) and in patients with chronic kidney disease (CKD) in whom they appeared to have beneficial actions in slowing the loss of kidney function above that achieved by other agents.

What is the best medication for hypertension?

Diuretics. There are three classes of diuretic drugs that are used to treat hypertension. Most commonly used are thiazide diuretics such as hydrochlorothiazide or chlorthalidone. There is not usually an increased urine flow after the first one or two days of taking these medications. Nevertheless, it is best to take them in ...

What are the different types of diuretics?

Different Drugs: Thiazide diuretics include: hydrochlorothiazide (usual starting dose 12.5 to 25 mg daily) or chlorthalidone (similar dose range). Loop diuretics include: furosemide (Lasix), bumetanide (Bumex), and torsemide (Demadex), torsemide has a rather longer duration and is preferred in patients with heart failure. Ethacrinic acid (Edecrin) is used in the rare patients who are allergic to diuretics. Loop diuretics are not as effective as thiazides in lowering blood pressure in patients with hypertension. They are used especially to treat edema (swelling of the ankles) or heart failure. However, unlike thiazides, they effective in patients with poor kidney function in lowering blood pressure or treating edema.

Is thiazide a first line drug?

For this reason, the Joint National Commission on Hypertension Detection Evaluation and Treatment (JNCVII) recommended thiazide diuretics as first line therapy for patients with hypertension, unless there were special reasons to select another type of drug.

Does Tempol lower blood pressure?

In so doing, tempol lowers blood pressure in animals and protects the blood vessels, kidneys, heart, and brain from damage. It is being developed as a potential therapy by the Hypertension, Kidney, and Vascular Research Center in collaboration with the Georgetown Drug Development Program.

Is salt intake a risk factor for hypertension?

Amongst those factors that are under our control which influence the probability of developing hypertension, an excessive dietary salt intake is probably the most important . Research in animal models at Georgetown at the Center for Hypertension, Kidney, and Vascular Research has linked dietary salt intake with oxidative stress that may underlie the hypertension and adverse consequences that follow from a persistently increased salt intake in the diet.

Is hypertension a rapidly developing field?

This is a rapidly developing field with extensive research, both by Centre scientists in the laboratory and clinical investigators in patients with hypertension. The following outlines some of the areas of research conducted at the Centre at Georgetown.

How does ACE inhibitor work?

ACE inhibitors work by blocking the angiotensin-converting enzyme, which converts angiotensin I to angiotensin II. Angiotensin II is a potent hormone that causes smooth muscles around blood vessels to contract, resulting in the narrowing of blood vessels and a rise in blood pressure.

How long does it take for ED to return after stopping blood pressure medication?

Bear in mind that different drugs have different half-lives which means it may take several days to several weeks for the drug to leave your body, therefore it may take some time for your erections to return after stopping a high blood pressure medication.

How does calcium channel blocker work?

Calcium channel blockers treat hypertension by blocking calcium from entering the cells of the heart and arteries. This relaxes blood vessels and improves blood flow.

How do diuretics help with blood pressure?

This helps lower blood pressure by decreasing the amount of blood the heart has to pump.

What is the purpose of alpha blockers?

Adrenaline and noradrenaline cause your blood vessels to narrow so blood has less space to flow through. Alpha-blockers allow your blood vessels to relax and widen, making it easier for blood to flow through .

Is high blood pressure a sign of ED?

High blood pressure (hypertension) is a leading cause of erectile dysfunction (ED). High blood pressure puts people at higher risk of ED: Men with high blood pressure are nearly twice as likely to have erectile dysfunction and impaired penile blood flow compared to their peers with normal blood pressure. 1 And it is estimated that one-third of all men with hypertension experience erectile dysfunction.

Can diuretics cause ED?

It's unknown exactly how diuretics affect erectile function, but some research suggests that diuretics can increase the occurrence of ED. 8 9 Common diuretics that are taken include:

What is ACE inhibitor?

ACE inhibitors are commonly prescribed to treat hypertension. Angiotensin-converting enzyme (ACE) inhibitor-based treatment regimens may not work as well at improving cardiovascular outcomes in black patients with hypertension compared with white patients, according to study findings published in the Journal of the American College of Cardiology. ...

Does ACE affect black patients?

ACE inhibitor use in black patients had a statistically significant rate of poor cardiovascular outcomes (8.7% vs 7.7%), but this did not occur in white patients (6.4% vs 6.7%). Black patients who received ACE inhibitor treatment were no more likely to develop adverse effects than white patients.

Can ACE inhibitors lower blood pressure?

Although ACE inhibitors are commonly prescribed to lower blood pressure in patients with hypertension , previous findings from randomized controlled clinical trials suggested that ACE inhibitor-based treatment regimens may not yield the same benefits in black patients.