What are the side effects of ace inhibitors
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Side Effects of ACE Inhibitors
Angiotensin-converting enzyme (ACE) inhibitors are widely prescribed for managing hypertension, heart failure, and diabetic nephropathy. Despite their effectiveness, these medications are associated with several side effects that can impact patient compliance and quality of life. This article synthesizes the key adverse effects of ACE inhibitors based on recent research findings.
Common Side Effects: Dry Cough and Hypotension
Dry Cough
One of the most frequently reported side effects of ACE inhibitors is a persistent dry cough. Studies indicate that the incidence of cough can range from 5% to 35% among patients treated with these medications 12610. 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 . This side effect is significant enough that it often leads to discontinuation of the drug .
Hypotension
ACE inhibitors can cause a significant drop in blood pressure, particularly after the first dose. This effect, known as first-dose hypotension, is more pronounced in patients with high plasma renin activity, those on diuretics, or those with heart failure 37. Proper patient selection and dose adjustment can mitigate this risk .
Electrolyte Imbalances: Hyperkalemia
Hyperkalemia
Hyperkalemia, or elevated potassium levels in the blood, is another common side effect of ACE inhibitors. This occurs due to the inhibition of aldosterone secretion, which leads to decreased potassium excretion 1237. While hyperkalemia is usually manageable with dietary modifications and careful monitoring, it can become severe in patients with renal impairment or those taking potassium-sparing diuretics .
Renal Effects: Proteinuria and Renal Dysfunction
Proteinuria and Renal Dysfunction
ACE inhibitors can cause proteinuria and renal dysfunction, although these effects are generally mild and reversible upon discontinuation of the drug 237. In patients with chronic kidney disease (CKD), ACE inhibitors are often used to slow disease progression, but they can also exacerbate renal impairment if not carefully monitored .
Dermatological and Other Less Common Side Effects
Skin Reactions
Dermatological side effects, including skin rashes and angioedema, have been reported with ACE inhibitor use. Angioedema, although rare, can be life-threatening if it involves the airways 67. Skin reactions are generally not cross-reactive among different ACE inhibitors, allowing for the possibility of switching to another agent if a reaction occurs .
Other Side Effects
Other less common side effects include dysgeusia (altered taste), hepatotoxicity, and blood dyscrasias such as neutropenia . These effects are generally idiosyncratic and less predictable.
Conclusion
ACE inhibitors are effective medications for managing several cardiovascular and renal conditions, but they come with a range of potential side effects. The most common adverse effects include dry cough, hypotension, hyperkalemia, and renal dysfunction. Less common but serious side effects like angioedema and skin reactions also warrant attention. Proper patient selection, dose adjustment, and monitoring can help mitigate these risks, making ACE inhibitors a valuable but carefully managed component of therapeutic regimens.
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