Hypertension, or high blood pressure, is a common and serious health condition. Effective management of hypertension is important to reduce the risk of heart attack, stroke, and kidney disease. A comprehensive approach to hypertension management is important, which often includes medication therapy. One of the most commonly used classes of medications for hypertension are the angiotensin-converting enzyme (ACE) inhibitors. This blog post will explore how ACE inhibitors work and considerations for their use in treating hypertension.

Also, see our blog – Treating High Blood Pressure

What is Hypertension?

Hypertension is often called the “silent killer” because it often has no symptoms until significant damage to vital organs has occurred. Blood pressure is the force exerted by blood against the walls of the arteries. When this pressure is consistently too high, it can damage the heart, blood vessels, kidneys, and other organs. Effective management of hypertension involves lifestyle modifications and, in many cases, medication to maintain blood pressure within a healthy range.

What are ACE Inhibitors?

ACE inhibitors are a class of medications that help relax blood vessels to lower blood pressure. They achieve this by blocking the angiotensin-converting enzyme which in turn prevents the body from creating a compound that is a potent constrictor of vessels which narrows blood vessels and raises blood pressure. By preventing the narrowing of blood vessels, ACE inhibitors help to lower blood pressure. ACE inhibitors also decrease aldosterone. Aldosterone is a hormone that causes the kidneys to retain sodium and water which can further increase blood pressure. Common ACE inhibitors medications include enalapril, lisinopril, ramipril, and benazepril, among others.

Considerations for Use:

1. Individualized Treatment: The choice of antihypertensive medication, including ACE inhibitors, should be tailored to each patient’s specific needs, medical history, and potential risk factors. ACE inhibitors are often used in conjunction with other blood pressure lowering medications.
2. Monitoring: Regular monitoring of blood pressure, kidney function, and potassium levels is important when using ACE inhibitors to ensure safety and effectiveness.
3. Not Used in Certain Populations: ACE inhibitors are not recommended for pregnant women, patients with a history of angioedema, or for patients already taking certain other medications.
4. Potential Side Effects: While ACE inhibitors are generally well-tolerated, they can cause side effects in some individuals. Side effects may include:

• Cough: A persistent dry cough is a well-known side effect of ACE inhibitors and may lead to discontinuation of therapy for some patients.
• Elevated Blood Potassium Levels (Hyperkalemia): ACE inhibitors can increase potassium levels in the blood, which can be dangerous if not monitored properly.
• Low Blood Pressure (hypotension): if the medication lowers blood pressure too much, it can result in symptoms of low blood pressure such as lightheadedness, dizziness, or fainting.
• Angioedema: A rare but serious side effect, angioedema is swelling of the face, lips, tongue and upper airways, and can be life-threatening when it interferes with the ability to breathe.

Conclusion:

ACE inhibitor medications play an important role in the management of hypertension. These agents offer one option for controlling blood pressure control. Patients and healthcare providers should work together to optimize hypertension treatment. With proper management, individuals with hypertension can reduce their risk of serious health complications. As always, it’s essential to follow the guidance of healthcare professionals with regular monitoring to ensure safe and effective therapy.

Resources:
1) Zestril (lisinopril) [package insert]. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2014.
2) Herman LL, Padala SA, Ahmed I, et al. Angiotensin-Converting Enzyme Inhibitors (ACEI) [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431051/
3) Goyal A, Cusick AS, Thielemier B. ACE Inhibitors. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430896/