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[Comparative evaluation of ACE inhibitors: which differences are relevant?].

M P Fischler1, F Follath

  • 1Departement für Innere Medizin, Universitätsspital, Zürich.

Schweizerische Medizinische Wochenschrift
|August 28, 1999
PubMed
Summary

Angiotensin-converting enzyme (ACE) inhibitors are vital for managing hypertension and heart failure. This review details their properties, usage, and adverse effects, guiding clinical application for better patient outcomes.

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Area of Science:

  • Pharmacology
  • Cardiology
  • Nephrology

Background:

  • ACE inhibitors are established treatments for hypertension, heart failure, and nephropathy.
  • Understanding their pharmacokinetic and pharmacodynamic profiles is crucial for effective use.

Purpose of the Study:

  • To review the clinical use of ACE inhibitors in Switzerland.
  • To present practical characteristics including bioavailability, elimination, and half-life.
  • To guide dosage adjustments in patients with renal, hepatic, and cardiac failure.

Main Methods:

  • Discussion of key clinical trials for various indications.
  • Presentation of pharmacokinetic and pharmacodynamic data for 11 available ACE inhibitors.
  • Categorization of ACE inhibitors based on half-life and elimination pathways.

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Main Results:

  • ACE inhibitors exhibit wide variations in oral bioavailability (11%-60%+).
  • Most are renally eliminated, but some have hepatic routes (benazepril, fosinopril, ramipril, spirapril, trandolapril).
  • Dosage adjustments in renal insufficiency are needed below 30 ml/min creatinine clearance; not required in liver disease, favoring renally excreted drugs.

Conclusions:

  • ACE inhibitors require careful initiation in severe heart failure with low doses and diuretics.
  • Common adverse effects include hypotension, cough, hyperkalemia, and renal failure.
  • Contraindicated in pregnancy due to potential fetal damage; angioedema and bone marrow suppression are less frequent risks.