Angiotensin converting enzyme inhibitors

Captopril
Lisinopril
Ramapril (HOPE study)


Indications

Hypertension, heart failure (CONSENSUS), post-MI (SAVE study), Primary prevention (HOPE trial).

Mechanism

Renin-angiotensin system: inhibits ACE and so reduces conversion of Angiotensin I to Angiotensin II. (1) ↓vasoconstriction, (2) ↓aldosterone, so reduces Na+ and H2O retention → ↓preload.
Bradykinin: reduces elimination of bradykinin which itself has a vasoconstrictor effect.

Method of administration

Stop diuretics. Lie down after first dose.

Adverse effects

Cough (bradykinin). ↑K+ Angioedema.

Contraindications

Renal artery stenosis (monitor U&E's), pregnancy (renal agenesis).