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ACE Inhibitors as CNS Drugs

Angiotensin-converting enzyme (ACE) has been an important drug target for a long time now - hundreds of millions of people (at the very least) have take ACE1 inhibitors for control of blood pressure, and the coronavirus pandemic brought plenty of new attention to the related ACE2 protein. But here's a new paper with an illustration of just how many different things are wired together in living systems - ACE has been moonlighting on us. It's been known for some time that the ACE protein itself is distributed among many tissues, with some abundances that suggest other functions. Particular brain regions for example, have unusual ACE expression levels, and while those could be related to angiotensin,…

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 Are Angiotensin-Converting Enzyme Inhibitors Effective in the Treatment of Hypertension in Black Patients?

High-quality evidence for avoiding ACEi use in patients identifying as Black was limited. Evidence has been found for the effectiveness of ACEis in blood pressure reduction in all populations, particularly when used in combination. How race was identified in most of the studies reviewed was not described. We conclude that factors other than the social construct of race should be used to guide antihypertensive therapy.

 Familiar Blood Pressure Drug Finds an Array of Novel Uses

It is a story reminiscent of the history of aspirin, a drug that began life as a mere pain reliever and turned out to be able to help prevent heart attacks and strokes, said Dr. Salim Yusuf, director of cardiology at McMaster University in Hamilton, Ontario. ''We're at the same place with ACE inhibitors that we were with aspirin 10 to 15 years ago,'' he said. ''We're finding that blood pressure lowering is only part of the story. We're finding that they have many mechanisms of action that are protective against cardiovascular disease.''

Articles of Interest

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.

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.

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

The discovery of the ACE inhibitors and the creation of captopril was one of the really great advances in cardiovascular medicine, alongside beta blockers, calcium channel blockers and statins.

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.

Is It Still Relevant to Discover New ACE Inhibitors from Natural Products? YES, but Only with Comprehensive Approaches to Address the Patients’ Real Problems: Chronic Dry Cough and Angioedema

Despite many publications related to the identification of new angiotensin-I-converting enzyme (ACE) inhibitors, especially peptides from natural products, the actual reason/s for why new ACE inhibitors need to be discovered are yet to be fully understood. New ACE inhibitors are pivotal to address serious side effects caused by commercially available ACE inhibitors in hypertensive patients. Despite the effectiveness of commercial ACE inhibitors, due to these side effects, doctors often prescribe angiotensin receptor blockers (ARBs).

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.

Pharmacologic Management of ACE-Inhibitor Angioedema

You and your attending discuss treatment options for bradykinin-mediated (ACE inhibitor) angioedema, including steroids and antihistamines. You consider alternative treatments such as TXA and FFP but given the stability of your patient elect to hold off on these. When you check on the patient 30 minutes later, he has since developed swelling to his tongue. He is having more difficulty, is not handling his secretions, and has difficulty speaking. You elect to nasotracheally intubate the patient and begin preparing your equipment. You again wonder about other pharmacologic treatments you should be administering, but securing his airway takes precedent.

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.

What we know about ACE inhibitors, high blood pressure and COVID‑19

First introduced in the early 1980s, ACE (angiotensin-converting enzyme) inhibitors were initially used for the treatment of high blood pressure, but their role has grown over the years to include the management of heart failure, heart attacks, diabetes and kidney disease.

Why certain medications can increase your risk in the heat

Millions of Americans take ACE inhibitors or ARBs to manage high blood pressure. But they can affect people's ability to sense thirst, potentially leaving them dehydrated.

Widely used hypertension drugs less effective in black patients

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

Resources

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.

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.

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.