What Are The Benefits And Side Effects Of ACE Inhibitors?

— -- Question: What are the benefits and side effects of ACE Inhibitors?

Answer: There are a lot of benefits to ACE inhibitor therapy some of them are much more at the molecular level, though there are more at the clinical level.

For instance, ACE inhibitors have been shown to increase nitric oxide concentration, increase bradykinin levels that lead to improvement in endothelial function. But at a clinical level, the benefits are basically that if you look across the cardiovascular spectrum if you look at coronary artery disease, congestive heart failure, stroke, renal dysfunction -- all across the vascular spectrum of risk, ACE inhibitors have been shown to reduce all-cause mortality, reduce hospitalization rate, and improve quality of life and symptoms for the patients.

So benefits are many, however these drugs are not without their side effects. The side effects could be grouped into those that are related actually to higher bradykinin levels which is cough and angioedema.

Angioedema is relatively rare, but cough is not in some series up to 20-25 percent of patients may develop cough and in those particular patients angiotensin receptor blockers maybe fairly beneficial, where the cough rate is relatively much less. The other side effects include that if the blood pressure were lowered too much the patient may develop dizziness. One thing that always concerns people is the worsening in the renal function.

Now we have to remember that ACE inhibitors related worsening renal function, is primarily a function of renal physiology and it does not necessary denote a poor kidney function per se. Most of the patients, if they don't have renal artery stenosis and they are not dehydrated, a little increase in creatine does not mean we need to cut back on the ACE inhibitor dosage or stop these medications altogether because in the long run these are really beneficial.

So when it comes to renal dysfunction, if somebody's creatine level goes up significantly, I think we need to rule out renal artery stenosis and we have to make sure that the patient is not dehydrated or has decreased their dose of diuretic and something like that. But most of the time there should not be a reason to stop ACE inhibitors therapy.