Angiotensin-converting enzyme inhibitors side effects--physiologic and non-physiologic considerations

Angiotensin-converting enzyme (ACE) inhibitors are increasingly recognized as having an important role in the treatment of hypertension and/or end-organ disease. The sheer number of ACE inhibitors in the United States--now numbering 10 different chemical entities--has created a sense of comfort with these compounds, which is particularly evident when these compounds are used in the patient with essential hypertension; conversely, when comorbid conditions are present in the ACE inhibitor-treated patient, circumstances change and physician vigilance becomes more of a necessity. ACE inhibitor therapy in patients with either cardiac and/or renal disease is as much an art as it is a science, and even in the most skilled hands can prove a challenging undertaking. This review discusses the physiologic and non-physiologic basis for side effects with ACE inhibition.