ACE Inhibitors

Question 1

Mechanism of Action

Ref: AMH

Answer 1

ACE inhibitors

• inhibits angiotensin I to angiotensin II conversion
• inhibit the breakdown of bradykinin.

Also inhibit the effect of angiotensin II-induced:

• vasoconstriction
• sodium retention
• aldosterone release
• sympathetic nervous activity

Question 2

Most common side effects

Answer 2

Hypotension 
Dizzyness
Cough 
Hyperkalemia 
Renal Impairment 
Fatigue
Nausea 

(Infrequent = Angiodema)
(Ref: AMH)

Question 3

ACE Inhibitors and Serum Creatinine & eGFR
What is the threshold for Creatinine and eGFR fro
a) continuing ACE
b) discontinuing ACE

(Ref: AMH)

Answer 3

Serum creatinine may increase after starting treatment or increasing the dose (usually stabilises within the first 2 months):

a) if increase is <30% or glomerular filtration rate (GFR) reduction is <25%, there is no need to adjust dose
b) if increase is >30% (or GFR reduction is >25%), investigate other causes and if necessary, reduce dose or stop ACE inhibitor and consider specialist referral.