Angiotensin converting enzyme inhibitors in hypertension: potential problems

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Aim:To review potential problems associated with the use of angiotensin converting enzyme (ACE) inhibitors in the treatment of patients with hypertension.Physiological problems:ACE inhibitors cause a drop in blood pressure depending on the circulating level of angiotensin II. This may be a problem in patients with severe congestive heart failure, so that it is important to monitor the effect of the ACE inhibitor in this group.Hyperkalaemia can develop in patients with severe renal impairment and potassium plasma levels should be monitored. Renal impairment is another potential problem and in hypertensive patients renal function should be measured before, and a few weeks after, starting treatment. This is especially important when there is any possibility of fibromuscular hyperplasia or atheroscerotic renal artery stenosis.Non-physiological problems:In addition to a cough, which is the most common problem, skin rashes, loss of taste, haematological effects and angioneurotic oedema are also encountered. The incidence of a cough with most ACE inhibitors is 5-10%.Conclusions:Compared to other antihypertensive drugs, ACE inhibitors have the major advantage of being well tolerated by most patients with few side effects.

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