ACE inhibitors: Mechanism of action and side effects

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With many advantages as well as good treatment results, ACE inhibitors are one of the most commonly used blood pressure medications today. What is the mechanism of action and side effects of ACE inhibitors?

1. Mechanism of action of ACE inhibitors

ACE inhibitors are one of the most popular classes of high blood pressure medications today. The mechanism of action of ACE inhibitors is to bind to the zinc ion of ACE, leading to a decrease in the rate of conversion to Angiotensin II (a potent vasoconstrictor). Therefore, ACE inhibitors have vasodilator effects, reduce peripheral resistance, and lower blood pressure. In addition to causing vasoconstriction, angiotensin II also causes many other harmful effects on the cardiovascular system such as altering the structure of the heart, blood vessels and kidneys. ACE inhibitors have additional protective effects on the heart and kidneys from remodeling. A decrease in Angiotensin II concentration also directly causes a decrease in aldosterone, leading to a slight increase in serum potassium and fluid excretion. In addition, ACE inhibitors can also act on the Kallikrein-kinin system to reduce degradation leading to increased bradykinin concentrations and increased prostaglandin synthesis, thereby also reducing peripheral resistance and lowering blood pressure. .

There have been many clinical trials demonstrating the role of ACE inhibitors in reducing cardiovascular risk, especially effective in reducing morbidity and mortality in patients with concomitant heart failure and heart failure. chronic kidney. Some rather preeminent properties of ACE inhibitors are no adverse effects on sugar and lipid metabolism, no effect on blood and urine uric acid levels, so they can be used for hypertensive patients with diabetes mellitus, dyslipidemia.

2. Common ACE inhibitors

Captopril is an ACE inhibitor that was first introduced in 1977. Since then, this group of drugs has about 15 different drugs. Some of the commonly used ACE inhibitors are:
Captopril Benazepril Enalapril Lisinopril Quinapril Perindopril Fosinopril Trandolapril Delapril Ramipril The drugs in the ACE inhibitor class have almost equivalent blood pressure lowering effects. Most drugs in this group have long-lasting effects for more than 24 hours, so they only need to be taken once a day. Except Captopril has a shorter duration of action (6-12 hours) and Moexipril has a shorter duration of action 12-18 hours.
In addition to high blood pressure, ACE inhibitors are also indicated in preventing, treating or improving symptoms in cases such as coronary artery disease, heart failure, diabetes, some kidney diseases. chronic, heart attack, scleroderma, migraine,...
Your doctor may prescribe ACE inhibitors in combination with other medications such as diuretics or calcium channel blockers. Do not combine ACE inhibitors with angiotensin receptor blockers or with direct renin inhibitors.
A feature of ACE inhibitors that should be considered is that the drug works better in young people than in older people; works better for whites than blacks. For blood pressure medications, depending on the specific characteristics of the patient, the doctor will choose the appropriate drug.

3. Side effects of ACE inhibitors

Some side effects of ACE inhibitors, patients may experience during treatment include:
Dry cough: this is a common side effect when taking ACE inhibitors. Sometimes the cough persists and the patient has to switch to another group of drugs. Hyperkalemia: many causes lead to this phenomenon, mainly due to decreased blood pressure to the kidneys, decreased secretion of aldosterone, decreased renal tubular function. Sudden hypotension: the drug may cause excessive hypotension at the first dose, especially in patients with heart failure, renal failure, taking diuretics, diarrhea, vomiting, etc. .. To avoid this, the drug is usually started at a low dose, then gradually increased. Angioedema: Unlike allergic angioedema, angioedema caused by ACE inhibitors does not cause urticaria. It is caused by increased activity of the Bradykinin metabolite and vasopressor effects that increase fluid accumulation and cause angioedema. In this case, the patient should immediately stop taking the drug and take timely intervention measures. Some other possible ACE inhibitor side effects include headache, loss of taste, maculopapular rash, leukopenia, dizziness, fatigue, diarrhea, nausea,...
The ACE inhibitors are contraindicated during pregnancy because of the risk of fetal injury and death. Therefore, if you are pregnant or planning to become pregnant, tell your doctor about other drugs to treat high blood pressure.

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Reference source: mayoclinic.org