HWN Suggests

From snake venom to ACE inhibitor — the discovery and rise of captopril

In the early 1980s, hypertension conferences were routinely enlivened by the poisonous Brazilian viper, Bothrops jararaca. With its striking zig-zag markings and aggressively protruding tongue, images of the snake were a welcome break from graphs and tables in presentations about captopril — the first of the angiotensin-converting enzyme (ACE) inhibitors, whose effects on blood pressure mechanisms mimicked those of the snake’s venom. When the cardiovascular juggernaut alighted in Sao Paulo, Brazil, for a major congress in 1984, there was even an opportunity for delegates to visit a snake farm and see the beast in all its glory.

“The discovery of the ACE inhibitors and the creation…

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  Enalapril (Vasotec)

The recommended initial dose in patients not on diuretics is 5 mg once a day. Dosage should be adjusted according to blood pressure response. The usual dosage range is 10 to 40 mg per day administered in a single dose or two divided doses.

  Lisinopril

In patients with uncomplicated essential hypertension not on diuretic therapy, the recommended initial dose is 10 mg once a day. Dosage should be adjusted according to blood pressure response. The usual dosage range is 20 mg to 40 mg per day administered in a single daily dose.

Articles of Interest

ACE inhibitors for treating hypertension

Cushman and Ondetti share the 1999 Albert Lasker Award in Clinical Medical Research for the discovery and development of captopril, the first orally active ACE inhibitor—the parent drug to what is today a pharmaceutical treasure trove of newer drugs in cardiovascular medicine.

Treatment of ACEi-induced angioedema

ACE-inhibitor induced angioedema (ACEI-AAG) accounts for about a third of angioedema cases presenting to the emergency department. ACE inhibitors are increasingly popular, with the new JNC 8 guidelines up-grading them to a first-line drug for hypertension.

ACE and ARB drugs. To be phased out?

Are you taking an ACE Inhibitor drug? Or perhaps one of their near cousin, ARB (Angiotensin Receptor Blocking) drugs? And did you know they were being phased out?

Angioedema

ACE Inhibitors (ACEI) •up to 1% incidence •angioedema is a class effect and is not dose dependent – symptoms can occur any time from a few hours up to 10 years after the initial dose (Winters et al, 2013) •more common in African Americans and patients on immunosuppressants •note that angioedema can occur in patients switched to an angiotensin receptor blocker

Angiotensin converting enzyme (ACE) inhibitors versus angiotensin receptor blockers for primary hypertension

Our analyses found no evidence of a difference in total mortality or cardiovascular outcomes for ARBs as compared with ACE inhibitors, while ARBs caused slightly fewer WDAEs than ACE inhibitors.

Angiotensin-Converting Enzyme Inhibitors in Hypertension: To Use or Not to Use?

Given the equal outcome efficacy but fewer adverse events with ARBs, risk-to-benefit analysis in aggregate indicates that at present there is little, if any, reason to use ACE inhibitors for the treatment of hypertension or its compelling indications.

Common Prescription Drugs Alter Blood’s Flow

Some drugs designed to affect vascular tone can also have cascading effects in the brain. Whether these unintended outcomes are helpful or harmful remains an open question.

Common Prescription Drugs Alter Blood’s Flow

Some drugs designed to affect vascular tone can also have cascading effects in the brain. Whether these unintended outcomes are helpful or harmful remains an open question.

Firazyr of Limited Help with Angioedema Caused by ACE Inhibitors

Firazyr (icatibant acetate) does not appear to be superior to placebo or symptomatic therapies in treating attacks of angioedema (swelling) caused by angiotensin-converting enzyme (ACE) inhibitors, a pooled analysis of three clinical studies shows.

High Blood Pressure Medications: ACE Inhibitors vs. ARBs

ACE Inhibitors and ARBS – these abbreviations may not look all that similar or even have any meaning to you as a patient. However, 1 in 3 adults have high blood pressure and are likely on one of these two types of medication even if they do not know it.

Lisinopril Side Effects Can Be Life Threatening: Beware Angioedema and ACE Inhibitors!

Lisinopril and other ACE inhibitors can cause a serious complication: angioedema. The face and neck swelling of angioedema could result in death.

Little HOPE for ACE inhibitors in revascularized patients

In an analysis recently published in the American Heart Journal, Kalavrouziotis et al found that the use of post-operative angiotensin-converting enzyme (ACE) inhibitors in coronary artery bypass graft (CABG) surgery was not associated with an improvement in survival or rehospitalizations.

Time for Guidelines to Recommend ARBs Over ACE Inhibitors?

The long-running dispute as to the supremacy of these two drug classes should be put to bed once and for all, say the authors of a new review.

What Can Asparagus Do For You?

Preliminary studies have shown that Asparagus Extract may inhibit the angiotensin-converting enzyme (ACE). ACE inhibitors relax the blood vessels, allowing them to expand and promote blood flow, thereby reducing blood pressure.

Widely used hypertension drugs less effective in black patients

Researchers are unsure why ACE inhibitors are far less effective for black patients.

Resources

BUPA

Angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) are mainly used to treat high blood pressure (hypertension) and heart failure. They can also reduce the risk of kidney damage in people with diabetes.

Cough–A nuisance side effect of ACE inhibitors

Another much less common adverse effect of ACE inhibitors is angioedema. However, angioedema is not a mere nuisance adverse effect as is cough, but it can be fatal. The incidence of angioedema has been shown to vary a great deal, and the PDR does not give us any reliable information in this regard.

Differences in the Clinical Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers: A Critical Review of the Evidence

Accordingly, we should aim at establishing a combination treatment based on ACE inhibitors in patients with cardiovascular co-morbidities (CAD, CHF, post-AMI). Rather, ARB agents may be prescribed to patients who do not tolerate ACE inhibitors.

Patient

ACE inhibitors prevent the body from creating a hormone known as angiotensin II. They do this by blocking (inhibiting) a chemical called angiotensin-converting enzyme. This has a variety of effects but essentially relaxes blood vessels and helps to reduce the amount of water re-absorbed by the kidneys.