ACE Inhibitors
Medications blocking angiotensin-converting enzyme for hypertension and heart failure
Definition
ACE (Angiotensin-Converting Enzyme) Inhibitors block the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. Results include vasodilation, lower blood pressure, reduced aldosterone (so less sodium/water retention), and cardiac/renal protection.
Common Drugs (end in '-pril')
- Lisinopril
- Enalapril
- Captopril
- Ramipril
- Benazepril
- Quinapril
Indications
- Hypertension
- Heart failure (reduces mortality)
- Post-MI
- Diabetic nephropathy (kidney protection)
- Chronic kidney disease
Side Effects
- Dry cough (bradykinin accumulation; 10 to 20% of patients)
- Angioedema (rare but life-threatening facial/airway swelling)
- Hyperkalemia
- Hypotension (especially first dose)
- Acute kidney injury (if renal artery stenosis)
- Teratogenic (contraindicated in pregnancy)
Nursing Considerations
- Monitor BP, potassium, BUN/creatinine.
- Teach to report persistent cough (may need to switch to ARB).
- Teach to report facial swelling immediately (angioedema is emergency).
- Avoid salt substitutes containing potassium.
- Do NOT use with direct renin inhibitors or ARBs.
- Hold if patient is dehydrated or receiving contrast.
NCLEX Relevance
Classic teaching: dry cough means switch to ARB (end in '-sartan'). Angioedema is emergency.