Angiotension converting enzyme (ACE) inhibitors:
Inhibits conversion of angiotensin I to angiotensin II. Angiotensin II is a potent vasoconstrictor and stimulator of aldosterone release (aldosterone increases retention of sodium and water increase in blood volume and increase in peripheral resistance). Blocking synthesis of angiotensin II decrease in blood pressure from reduced vasoconstriction and decrease in afterload from net water loss (from less aldosterone secretion)
Commonly used when beta-blockers and/or diuretics are ineffective.
eg Captopril, Fosinopril, Enalapril, Lisinopril, Perindopril, Quinapril, Ramipril, benazepril
• indicated for hypertension, heart failure, myocardial infarction
• inhibit ACE inhibits production of angiotensin II removes influence of angiotensin II vasodilation (arterioles > venules) and reduction of blood volume (by acting in kidneys)
• have little or no effect on cardiac output
• most effective when hypertension is result of increased levels of renin
Adverse effects:
Renal failure, cough, fatigue, headache, diarrhoea, skin rashes, angioedema, hypotension (high risk on first dose), hyperkalaemia (due to inhibition of ADH)
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