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ACE inhibitors (ACEIs) are a class of drugs that work by inhibiting angiotensin-converting enzyme (ACE). ACE inhibitors as a drug class have names ending in the suffix -pril, including lisinopril, enalapril, ramipril, captopril, and benazepril. The clinical effects of ACE inhibitors can be primarily broken into two main effects: first, they prevent conversion of angiotensin I into angiotensin II by ACE. Second, ACE is also used for bradykinin breakdown, so ACE inhibitors can increase bradykinin levels.
Reducing levels of angiotensin II decreases blood pressure by way of reducing vasoconstriction and reducing aldosterone release. This can be helpful in the treatment of hypertension, although high doses of ACE inhibitors can go too far the other way and induce hypotension. By reducing systemic blood pressure, ACE inhibitors reduce the work of the heart and are therefore useful in the treatment of heart failure. In heart failure patients, ACE inhibitors are first-line because they confer a mortality benefit. ACE inhibitors also have a renoprotective effect, which means that they can protect the kidneys in patients with hypertension or diabetes.
Besides the hypotension that we already talked about, other side effects of ACE inhibitors include angioedema and the development of a dry cough, both which are related to increased bradykinin levels in the body. ACE inhibitors can also cause hyperkalemia by reducing aldosterone release. Lastly, ACE inhibitors are teratogenic and should be particularly avoided in pregnant women to reduce the risk of kidney malformations in the fetus.
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