ACE inhibitors

These can be used in either step 1 or step 2.  How this drug class works is in the RAA cascade.  It blocks the enzyme that converts angiotensin 1 to angiotensin 2, meaning angiotensin 2 won’t be created.  Without angiotensin 2, you can’t have increased blood pressure because you don’t get vasoconstriction.  This also means there won’t be aldosterone so there won’t be sodium and water retention so the blood pressure will go down.

Congestive Heart Failure: This was the breakthrough drug class that saved patients with CHF because it helped break up the ascites cycle.  If we don’t have the angiotensin 2 and the build up of BP, we don’t have as much strain on the heart.  If we don’t have aldosterone, we don’t have the build up of sodium and water and there won’t be as much strain on the heart.

Diabetic renal sparing: Triple XXX in health care if a person has all 3:  Hypertension, hypercholesterolemia and diabetes:  The risk of mortality shoots up dramatically.  We can’t explain the mechanism but we’ve found that putting a diabetic on an ACE inhibitor protects their kidneys.

Side Effect: Patients could develop a side effect that really bothers them.  And that is a dry, nonproductive cough.

ACE inhibitors

Hint: They all end in -pril

• Captopril (Capoten) – p.o.
• Enalapril (Vasotec) – p.o.
• Lisinopril (Zestril, Prinivil) – p.o.
• Benazepril (Lotensin) – p.o.
• Fosinopril (Monopril) – p.o.
• Quinapril (Accupril) – p.o.
• Ramipril (Altace) – p.o.