Angioedema, from ACE inhibitors

Cough and angioedema are the most common causes of ACE inhibitor intolerance. Caution should be exercised when ARBs are used in patients with angioedema from ACE inhibitors because cross-reactivity has been reported. ARBs are not alternatives in patients with hypotension, hyperkalemia, or renal insufficiency due to ACE inhibitors because they are just as likely to cause these adverse effects. 

The ACC/AHA guidelines, developed before the Val-HeFT, CHARM, and VALIANT trials were completed, indicate that ARBs should not be considered equivalent or superior to ACE inhibitors and that they should be considered in patients who are intolerant of ACE inhibitors. Collectively, the results of these trials clearly support this recommendation. Eor patients unable to tolerate an ACE inhibitor, usually due to intractable cough or angioedema, an ARB is a safe and effective alternative, although caution stiU should be exercised when it is used in patients with angioedema from ACE inhibitors. ARBs are not an alternative in patients with hypotension, hyperkalemia, or renal insufficiency secondary to ACE inhibitors because they are as likely to cause these adverse effects. The specific drugs and doses proven to be effective in chnical trials should be used. The role of ARBs as an adjunct to ACE inhibitors remains controversial. 

Outcome Tissue swelling (lips and tongue, larynx and pharynx) Sequela Angioedema from ACE inhibitors... 

Besides hypotension, the most frequent adverse reaction to an ACE inhibitor is cough, which may occur in up to 30% of patients. Patients with ACE inhibitor cough and either clinical signs of heart failure or LVEE less than 40% may be prescribed an angiotensin-receptor blocker (ARB). Both candesartan and valsartan have improved outcomes in clinical trials in patients with heart failure. Other less common but more serious adverse effects of ACE inhibitors include acute renal failure, hyperkalemia, and angioedema. Although some data have suggested that aspirin use may decrease the benefits from ACE inhibitor treatment, a systematic review of more than 20,000 patients demonstrated that ACE inhibitors improve outcome irrespective of treatment with aspirin. ... 

Contraindications History of angioedema from previous treatment with ACE inhibitors... 

Patients with angioedema from an ACE inhibitor also can experience this with an ARB, but the exact incidence of cross-reactivity is not known. The ACC/AHA guidelines for... 

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