ACE Inhibitors

The first ACE inhibitor was approved by the FDA in 1981 . They are prescribed mainly for hypertension, coronary artery disease, heart failure, and rehabilitation after a heart attack. Some doctors may also prescribe these drugs for migraines, diabetes or certain kidney diseases. But are they safe for long term use? And what are the side affects you might experience while taking them? And how well do they actually work?

According the modern studies they are safer than alpha blockers and alpha-2 agonists. ACE inhibitors work in two main ways. They decrease the activity of the angiotensin converting enzyme, which in turn decreases the formation of angiotensin II. Angiotensin II is a vasoconstrictor, so decreasing this widens the blood vessels. The second effect they have is increasing bradykinin, which also dilates the blood vessels. Years ago if a patient had a heart attack and was admitted to the hospital, they were sent home with a beta blocker once treated. Times have changed, and the larger majority of physicians are now recommending ace inhibitors after a heart attack. This is the case because ace inhibitors seem to not have as many negative side affects in the short term, and are a lot easier to stop than beta blockers. Like beta blockers, ace inhibitors help somewhat to make the heart not beat as hard. This is why they are also prescribed for left ventricular dysfunction.

When starting an ace inhibitor your doctor will usually have you taking the lowest dosage first to see how you react to it. Some studies have shown diabetic patients with certain kidney problems have slowed kidney failure with ace inhibitor treatment. For migraines they have been shown to reduce frequency and severity. Usually for migraines minimal dosages are prescribed. Using them for high blood pressure seems to yield successful results for most people, with the average user reporting at least a 10 point drop in the systolic and diastolic readings with low to moderate dosages. Another reason ACE inhibitors are prescribed for hypertension more often these days is because patients have seen more results with smaller dosages of this drug in comparison with other hypertension medication.

Side effects from taking these drugs may include dizziness, fatigue, chest pain, headaches, drowsiness, fainting, weakness, increased blood potassium levels, loss of taste, lowered haemoglobin, rashes, increased uric output levels, increased creatinine levels, increased BUN levels, sun sensitivity, blurred vision, confusion, sweating, body aches, sore throat, cough, running nose, nausea, fever, chills, general feeling of being unwell, liver issues, and kidney failure.

Some people seem to tolerate this drug better than others. With some patients saying they took it for years with minimal side effects, and other patients having a severe allergic reaction to the ACE inhibitor that was life threatening. However almost every single person taking this medication complained of the same thing. A persistent and annoying cough. A very large percentage of people experience this. The cough can be dry and can worsen in some people with long term use. This happens because ACE inhibitors cause the blood vessels in the lungs to expand. Which is why ACE inhibitors are never a good idea for someone with pre-existing lung conditions, as they can potentially worsen the symptoms of Asthma or COPD. After stopping this drug most patients reported that the cough went away rather quickly, however a few patients who were long term ACE inhibitor users had the cough persist for a little while after the drug was discontinued.  

OK, let’s talk long term side affects. Because of this drugs ability to modify angiotensin output, it can potentially harm the liver. A few long term users have reported liver problems after taking this drug. Some patients who had pre-existing liver conditions before taking this drug suffered liver damage after being on the drug for only a short period of time. It should be noted however that the larger majority of people taking this drug short term did not obtain liver issues.

Another long term side affect is high potassium levels. Potassium levels can become dangerously high in some people, which in turn can cause the heart to beat irregularly. Potassium levels should be checked routinely if a patient is taking any brand ACE inhibitor.

In some patients ACE inhibitors can be harsh on the kidneys. Patients with heart failure or some form of heart dysfunction can have a hindered blood volume output. If a patient is not producing as much blood in their circulatory system, ACE inhibitors could agonize this problem more. The reaction of the angiotensin inhibition can  cause a decrease in blood volume. In patients with this issue this could lead to dangerously low blood volume levels if ACE inhibitor treatment is initiated. This will in turn have a very negative affect on renal output. Some patients may only experience a slight decline in kidney function and nothing else.

The most serious and immediate side affect of ACE inhibitors is an allergic reaction. It is a small percentage of people but some patients can develop swelling of the throat and different areas of the face. This is very serious and you should call 911 immediately if this happens.

When stopping ACE inhibitors abruptly patients will most likely experience a rebound effect. One study showed blood pressure levels peaked within 48 hours of stopping the drug. And after four to five days of no longer taking this drug blood pressure evens out and starts to go back down to what it was before ever introducing the drug to the body. As blood pressure medications go this is not as bad as many others. However the rebound affect can still be dangerous under the right circumstances. It is usually best to taper down the dosage slowly to the minimum before stopping completely. Always consult your doctor before stopping ace inhibitors.

I hope everyone found this helpful, the point of this article is to make sure you have all the facts about this drug. This way you can weigh out all the risks involved and decide if this is a treatment that is right for you. Remember that there are many different brands of this medication, and some might work better than others. Some will cause more or less side affects than others. Although some medical data claims the side affects of ACE inhibitors are not quite as bad as other blood pressure medications, it is important to note they are certainly present. As with any drug. Thank you for your continued support of Blood Pressure Authority.