11: ACE Inhibitors

Question 1

What are the general effects of type I and type II angiotensin receptors?

Answer 1

Type I = vasoconstrictor

Type II = vasodilator

Question 2

What are the pathophysiologic effects of AII?

Answer 2

Myocytes
- Hypertrophy, apoptosis, inc. O2 consumption
Fibroblast
- Hyperplasia, collagen synthesis
Peripheral artery
- Vasoconstriction, EC dysfunction, hypertrophy
Coronary artery
- Vasoconstriction, atherosclerosis, thrombosis

Question 3

What is the suffix of ARBs?

Answer 3

‘sartan’

Question 4

Why are AII and aldosterone levels though to increase after a few months of ACE-Is treatment?

Answer 4

Chymase activity (other proteases breaking down AI to AII)

Question 5

What is the most commonly used ACEi and ARB in clinical practice?

Answer 5

Cilazapril 0.5-5mg od

Candesartan 4-32 mg od

Question 6

What are the effects on:

• Vascular tone
• Blood volume
• Sympathetic activity
• Cardiac and vascular hypertrophy

Answer 6

All decreased

Question 7

What are the indications for ACE-Is vs ARBS?

Answer 7

ACEi - hypertension, CCF

AIIA - hypertension, HF, ACEi intolerant patients

Question 8

What is the first line treatment for hypertension?

Answer 8

• Diuretic + ACEi

Question 9

What are the side effects of ACE-Is and AIIAs?

Answer 9

• Dry cough
• Hyperkalemia
• Renal function deterioration
• Hypotension
• Angioedema

Question 10

In which patient groups should caution be used with ARBs and ACEis?

Answer 10

• Hyperkalemic
• Renal impairment
• Diurised

Question 11

In which patient groups is use an absolute contraindication?

Answer 11

• Bilateral renal artery stenosis

- Pregnancy