Side effects of ace inhibitors
Pro Research Analysisby 
Searched over 200M research papers
Side Effects of ACE Inhibitors
Common Side Effects: Dry Cough and Hypotension
Angiotensin-converting enzyme (ACE) inhibitors are widely prescribed for conditions such as hypertension and heart failure. However, they are associated with several common side effects. One of the most frequently reported adverse effects is a persistent dry cough, which affects a significant proportion of patients 123. The exact mechanism behind this cough is not fully understood, but it is believed to be related to the accumulation of bradykinin and substance P in the respiratory tract .
Another prevalent side effect is hypotension, particularly noticeable after the first dose. This can be managed by starting with a lower dose and gradually increasing it 23. Hypotension is more likely to occur in patients who are volume-depleted or on diuretics .
Electrolyte Imbalances: Hyperkalemia
ACE inhibitors can lead to hyperkalemia, an elevated level of potassium in the blood. This occurs because these drugs inhibit the renin-angiotensin-aldosterone system, which normally promotes potassium excretion 123. Hyperkalemia is more common in patients with renal impairment or those taking potassium-sparing diuretics. Monitoring potassium levels and adjusting dietary intake can help manage this risk .
Renal Dysfunction and Proteinuria
Renal dysfunction is another significant concern with ACE inhibitors. These drugs can cause a decline in renal function, particularly in patients with pre-existing kidney disease or those who are dehydrated 3910. Proteinuria, or the presence of excess proteins in the urine, has also been observed, although it is often difficult to distinguish whether this is due to the underlying disease or the medication itself 23.
Dizziness and Other Neurological Effects
Dizziness is a relatively common side effect, often related to the blood pressure-lowering effects of ACE inhibitors 19. This can be particularly troublesome for elderly patients or those on multiple antihypertensive medications. In some cases, dizziness may lead to falls and other complications.
Dermatological Reactions: Rash and Angioedema
Skin reactions, including rashes, are reported with ACE inhibitor use. These reactions are generally mild but can be bothersome 28. More seriously, ACE inhibitors can cause angioedema, a potentially life-threatening condition characterized by swelling of the deeper layers of the skin, often around the eyes and lips, and sometimes the throat 37. Angioedema is relatively rare but requires immediate medical attention due to the risk of airway obstruction.
Hematological Effects: Neutropenia and Anemia
ACE inhibitors can cause hematological side effects such as neutropenia (a decrease in white blood cells) and anemia (a decrease in red blood cells). These effects are generally rare and more likely to occur in patients with autoimmune diseases or those on high doses of the medication 23.
Contraindications and Special Populations
ACE inhibitors are contraindicated in pregnancy due to the risk of fetal harm, including renal dysfunction and skeletal malformations . They should also be used with caution in patients with chronic kidney disease, where the balance between therapeutic benefits and adverse effects must be carefully managed .
Conclusion
While ACE inhibitors are effective for managing hypertension and heart failure, they come with a range of potential side effects. Common issues include dry cough, hypotension, hyperkalemia, and renal dysfunction. Less frequent but serious side effects like angioedema and significant hematological changes also warrant attention. Proper patient selection, dose adjustment, and monitoring can help mitigate these risks, making ACE inhibitors a valuable but carefully managed tool in clinical practice.
Sources and full results
Most relevant research papers on this topic