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Natural Health News Articles
Page: 1
| Posted: 7th August 2004 |
| ACE Inhibitors (E.g. Vasotec) |
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ACE inhibitors, or inhibitors of Angiotensin-Converting Enzyme, are a group of pharmaceuticals that are used primarily in treatment of hypertension and congestive heart failure.
Indications of ACE inhibitors include:
prevention of cardiovascular disorders
congestive heart failure
hypertension
left ventricular dysfunction
prevention of nephropathy in diabetes mellitus
In several of these indications, ACE inhibitors are used first-line as several agents in the class have been clinically shown to be superior to other classes of drugs in the reduction of morbidity and mortality.
ACE inhibitors are often combined with diuretics in the control of hypertension (usually a thiazide), when an ACE inhibitor alone proves insufficient; and in chronic heart failure (usually frusemide) for improved symptomatic control. Thus there exists, on the market, combination products combining an ACE inhibitor with a thiazide (usually hydrochlorothiazide) in a single tablet to allow easy administration by patients.
Adverse effects
Common adverse drug reactions include: hypotension, cough, hyperkalaemia, headache, dizziness, fatigue, nausea, renal impairment (AMH, 2004).
A persistent dry cough is a relatively common adverse effect believed to be associated with the increases in bradykinin levels produced by ACE inhibitors. Patients who experience this cough are often switched to angiotensin II receptor antagonists.
Rash and taste disturbances, infrequent with most ACE inhibitors, are more prevalent in captopril and is attributed to its sulfhydryl moiety.
Renal impairment is a significant adverse effect of all ACE inhibitors, and is associated with their effect on angiotensin II-mediated homeostatic functions such as renal bloodflow. ACE inhibitors can induce or exacerbate renal impairment in susceptible patients. This is especially a problem if the patient is also concomitantly taking an NSAID and a diuretic - the so-called "triple whammy" effect - such patients are at very high risk of developing renal failure (Thomas, 2000).
Examples of ACE inhibitors
ACE inhibitors can be divided into three groups based on their molecular structure:
Sulfhydryl-containing ACE inhibitors
captopril (Capoten®), the first ACE inhibitor
Dicarboxylate-containing ACE inhibitors, the largest group including:
enalapril (Vasotec®/Renitec®)
ramipril (Altace®/Tritace®)
quinapril (Accupril®)
perindopril (Coversyl®)
lisinopril (Lisodur®)
Phosphonate-containing ACE inhibitors
Natural alternatives include, under strict supervision, calcium, magnesium and potassium. |
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