ACE inhibitors

From WardWiki - Foundation Doctor Helper

ACE inhibitors prevent the conversion of angiotensin I to angiotensin II in the lungs and are an important tool in interupting the renin angiotensin aldosterone axis when in positive feedback. It has become invaluable in left ventricular failure, hypertension and diabetes. They can produce a dry cough in 10% of patients which obliges a change to angiotensin II antagonists.

Contents 1 Actions 2 Indications 3 Contraindications 4 Typical starting doses 5 Links

Actions

• Reduce left ventricular afterload
• Reduce left ventricular remodelling after myocardial infarction
• Reduce proteinuria, slowing damage in chronic kidney disease

Indications

• Hypertension inc. in CKD
• Left heart failure
• Post ACS
• Chronic kidney disease in diabetics
• Proteinuria in CKD
• Post stroke

Contraindications

• Hypotension
• New or worsening acute kidney injury
• Angioedema
• Hyperkalemia, caution with spironolactone or Sando K co-prescription
• Post surgery the renin angiotensin aldosterone axis is APPROPRIATELY HIGH. Caution with ACEi here
• Pre surgery cancel for up to seven days after discussion with surgeon for the same reason, can cause hypotension on anaesthetic induction.

Typical starting doses

• Ramipril 1.25mg ON
• Perindopril 2mg ON
• Enalapril 2.5mg ON
• Captopril 6.25mg BD in borderline hypotensives with heart failure

Links

• Heart failure

http://guidance.nice.org.uk/CG108/Guidance/pdf/English

• Chronic Kidney Disease

http://www.nice.org.uk/nicemedia/live/12069/42116/42116.pdf

• Hypertension

http://www.ascotstudy.org/home.htm