ANGIOTENSIN-CONVERTING ENZYME-INHIBITORS IN HYPERTENSION - POTENTIAL PROBLEMS

Aim: To review potential problems associated with the use of angiotens in converting enzyme (ACE) inhibitors in the treatment of patients wit h 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 i n this group. Hyperkalaemia can develop in patients wth severe renal i mpairment and potassium plasma levels should be monitored. Renal impai rment is another potential problem and in hypertensive patients renal function should be measured before, and a few weeks after, starting tr eatment. This is especially important when there is any possibility of fibromuscular hyperplasia or atheroscerotic renal artery stenosis. No n-physiological problems: In addition to a cough, which is the most co mmon problem, skin rashes, loss of taste, haematological effects and a ngioneurotic oedema are also encountered. The incidence of a cough wit h most ACE inhibitors is 5-10%. Conclusions: Compared to other antihyp ertensive drugs, ACE inhibitors have the major advantage of being well tolerated by most patients with few side effects.