ACE Inhibitors

Key points

• MOA: inhibit conversion of angiotensin I → angiotensin II.
• Uses: first-line hypertension in younger patients · heart failure · diabetic nephropathy · secondary prevention of IHD; less effective in Afro-Caribbean hypertension.
• Side-effects: dry cough ~15% (bradykinin, may appear up to a year later) · angioedema · hyperkalaemia · first-dose hypotension (esp. with diuretics).
• Cautions/contraindications: pregnancy & breastfeeding · renovascular disease (bilateral renal artery stenosis) · aortic stenosis · high-dose diuretics (> 80 mg furosemide/day) · hereditary/idiopathic angioedema.
• Monitoring: urea & electrolytes after starting/titration.

Decision points in this pathway

• Any caution/contraindication?

The full step-by-step algorithm, including what to do at each branch, opens in the app for approved members.