Related Experiment Videos
Angiotensin-converting enzyme (ACE) inhibitors and angio-oedema
1Professorial Unit, St John's Institute of Dermatology, St Thomas's Hospital, London, UK.
Insights
Angiotensin-converting enzyme inhibitors (ACEIs) can cause angio-oedema, a rare but serious side effect. Prompt recognition and drug withdrawal are crucial for managing this potentially fatal condition.
Area of Science:
- Pharmacology
- Cardiology
- Allergy and Immunology
Background:
- Angiotensin-converting enzyme inhibitors (ACEIs) are widely prescribed for hypertension, heart failure, and post-myocardial infarction care.
- A significant, though often unrecognized, adverse effect of ACEIs is angio-oedema.
- The incidence of angio-oedema in patients on ACEIs ranges from 0.1% to 0.7%.
Purpose of the Study:
- To highlight the association between ACEI use and angio-oedema.
- To describe the clinical presentation, timing, and severity of ACEI-induced angio-oedema.
- To provide guidance on the management and contraindications of ACEI-induced angio-oedema.
Main Methods:
- Review of clinical data and literature on ACEI-induced angio-oedema.
- Analysis of onset timing, affected areas, and severity of angio-oedema.
- Evaluation of treatment strategies and contraindications for ACEI therapy.
Main Results:
- Angio-oedema onset typically occurs within the first week of ACEI treatment but can be delayed.
- Head and neck region, including the larynx, are most commonly affected, posing a risk of fatal airway obstruction.
- Severe cases may necessitate emergency interventions like adrenaline and intubation.
Conclusions:
- ACEI-induced angio-oedema requires immediate drug cessation and alternative antihypertensive therapy.
- Patients with a history of idiopathic angio-oedema or C1 esterase inhibitor deficiency should not receive ACEIs.
- Awareness and prompt management are vital to mitigate the risks associated with ACEI-induced angio-oedema.
Abstract:
Angiotensin-converting enzyme inhibitors (ACEIs) are used increasingly for the treatment of hypertension and chronic heart failure, and they reduce mortality when given after myocardial infarction. Of the patients prescribed these drugs 0.1-0.7% develop angio-oedema, but the association is not widely recognized. In 60% of cases the onset occurs during the first week of treatment; however, it may be considerably delayed. Angio-oedema nearly always occurs on the head and neck, frequently involving the mouth, tongue, pharynx and larynx. The course is unpredictable, and attacks vary in severity from mild to fatal from laryngeal obstruction. Severe ACEI-induced angio-oedema may require emergency treatment with adrenalin and early intubation. The drug should be withdrawn in any patient who presents with ACEI-induced angio-oedema, and treatment continued with an appropriate drug of a different class. Therapy with ACEIs is contraindicated in patients with a prior history of idiopathic angio-oedema, or in patients with hereditary or acquired C1 esterase inhibitor deficiency.