Angiotensin-converting enzyme inhibitors patients

Stumpf JL. Shehab N. Patel AC Safety of angiotensin-converting enzyme inhibitors in patients with insect venom allergies. Ann Pharmacother 2006 40 699-703. 

Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs. diuretic The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002 288(23) =2981-2997. 

To control risk factors and prevent major adverse cardiac events, statin therapy should be considered in all patients with ischemic heart disease, particularly in those with elevated low-density lipoprotein cholesterol. In the absence of contraindications, angiotensin-converting enzyme inhibitors should be considered in ischemic heart disease patients who also have diabetes melli-tus, left ventricular dysfunction, history of myocardial infarction, or any combination of these. Angiotensin receptor blockers... 

Formulate a monitoring plan for a patient with ST-segment elevation acute coronary syndrome receiving fibrinolytics, aspirin, unfractionated heparin, intravenous nitroglycerin, intravenous (3-blockers followed by oral P-blockers, an angiotensin-converting enzyme inhibitor, and a statin. 

Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers decrease protein excretion and are the drugs of choice for hypertension in patients with CKD. 

Medications can increase the risk of hyperkalemia in patients with CKD, including angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, used for the treatment of proteinuria and hypertension. Potassium-sparing diuretics, used for the treatment of edema and chronic heart failure, can also exacerbate the development of hyperkalemia, and should be used with caution in patients with stage 3 CKD or higher. 

Hypotonic hyponatremia with an increase in ECF is also known as dilutional hyponatremia. In this scenario, patients have an excess of total body sodium and TBW however, the excess in TBW is greater than the excess in total body sodium. Common causes include CHF, hepatic cirrhosis, and nephrotic syndrome. Treatment includes sodium and fluid restriction in conjunction with treatment of the underlying disorder—for example, salt and water restrictions are used in the setting of CHF along with loop diuretics, angiotensin-converting enzyme inhibitors, and spironolactone.15... 

Angiotensin-converting enzyme inhibitor (ACEI) to patients with CAD and diabetes or LV dysfunction... 

Elevated blood pressure is common after ischemic stroke, and its treatment is associated with a decreased risk of stroke recurrence. The Joint National Committee and AHA/ASA guidelines recommend an angiotensin-converting enzyme inhibitor and a diuretic for reduction of blood pressure in patients with stroke or TIA after the acute period (first 7 days). Angiotensin II receptor blockers have also been shown to reduce the risk of stroke and should be considered in patients unable to tolerate angiotensinconverting enzyme inhibitors after acute ischemic stroke. 

Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers have shown efficacy in preventing the clinical progression of renal disease in patients with type 2 DM. Diuretics are frequently necessary due to volume-expanded states and are recommended second-line therapy. 

Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are generally recommended for initial therapy. Many patients require multiple agents, so diuretics, calcium channel blockers, and /)-blockers are useful as second and third agents. 

Antihypertensive therapy should be initiated in diabetic or nondiabetic CKD patients with an angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin II receptor blocker. Nondihydropyridine calcium channel blockers are generally used as second-line antiproteinuric drugs when ACEIs or angiotensin II receptor blockers are not tolerated. 

Exner, C.V., et al., "Lesser Response to Angiotensin-Converting-Enzyme Inhibitor Therapy in Black as Compared with White Patients with Left Ventricular Dysfunction," N. Engl. J. Med., 344, 1351-1357 (2001). 

Angiotensin converting enzymes- inhibitors (ACE-inhibitors) are a group of drugs that are very potent in dilating the blood vessels and through this mechanism lower the blood pressure. Therefore they can also improve heart function in patients with heart failure. In some cases they are also used for preventing renal failure in persons with hypertension and/or diabetes. Paradoxically, this later use of ACE-inhibitors... 

As angiotensin-converting enzyme inhibitors influence protein excretion in renal disease, Gansevoort et al. (G2) and Keilani et al. (K10) investigated serum Lp(a) concentrations in patients treated with Lisinopril resp. fosinopril and detected a reduction. 

All angiotensin-converting enzyme inhibitors including enalapril, may precipitate a hypoglycaemic attack in a diabetic patient because they may potentiate the effect of sulphonylureas. 

Q65 Angiotensin-converting enzyme inhibitors should be used with caution in patients ... 

Angiotensin-converting enzyme inhibitors should be used with caution in patients taking diuretics because of an enhanced hypotensive effect. Angiotensin-converting enzyme inhibitors should also be used with caution in patients with renal impairment. Renal function needs to be monitored in patients with renovascular disease. 

Moreover, whether or not hypertension is caused by an elevated level of renin or other reasons, angiotensin-converting enzyme inhibitors lower both systolic and diastolic arterial pressure in hypertensive patients, and their effects are enhanced by diuretics. Angiotensin-converting drugs of this series (captopril, enalapril) are effective antihypertensive drugs used both independently and in combination with other drugs to treat all types of hypertension as well as to treat cardiac insufficiency. 

Because the above trials showed a >50% relative reduction in total mortality with ICD therapy, MADIT II used broader entry criteria for primary prevention of SCD, removing the criteria for NSVT and EPS 1,232 patients with a history of MI > 30 days prior and an EF < 30% were randomized to conventional therapy or ICD implantation [10]. Conventional therapy was comparable in both arms and included a high rate of use of beta blockers, angiotensin-converting enzyme inhibitors, and statins (over two thirds for all medications in both arms). The trial was stopped early at 20 months because the relative reduction in total mortality... 

Gattis WA, Larsen RL, Hasselblad V, Bart BA, O Connor CM. Is optimal angiotensin-converting enzyme inhibitor dosing neglected in elderly patients with heart failure . Am Heart J 1998 136(l) 43-8. 

The Angiotensin Converting Enzyme Inhibitors (ACE-I) are recommended for all CAD patients, especially those with Diabetes Mellitus (DM) and/or left ventricle (LV) dysfunction. 

Potentially as effective as or more effective than angiotensin-converting enzyme inhibitors, without cough no evidence yet for reduction in morbidity and mortality as first-line agents in hypertension whether they provide the same cardiac and renal protection also still tentative like ACE inhibitors, less effective in black patients... 

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