Which medications in the drug class ACEIs are used in the treatment of Hypertension?

Updated: Feb 22, 2019
  • Author: Matthew R Alexander, MD, PhD; Chief Editor: Eric H Yang, MD  more...
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Answer

ACEIs

Angiotensin converting enzyme inhibitors (ACEIs) are the treatment of choice in patients with hypertension, chronic kidney disease, and proteinuria. ACEIs reduce morbidity and mortality rates in patients with heart failure, patients with recent myocardial infarctions, and patients with proteinuric renal disease. ACEIs appear to act primarily through suppression of the renin-angiotensin-aldosterone system. ACEIs prevent the conversion of angiotensin I to angiotensin II and block the major pathway of bradykinin degradation by inhibiting ACE. Accumulation of bradykinin has been proposed as an etiologic mechanism for the side effects of cough and angioedema. ACEIs can cause injury or even death to a developing fetus. In pregnant patients, ACEIs should be discontinued as soon as possible.

It is important to note that the blood-pressure-lowering effects of ACEIs and thiazides are approximately additive, and there is also the potential for hyperkalemia when ACEIs are coadministered with potassium supplements or potassium-sparing diuretics. In addition, a study by Harel et al found an increased risk for hyperkalemia when aliskiren, a direct renin inhibitor, and ACEIs or angiotensin receptor blockers (ARBs) were used together. [145] Careful monitoring of serum potassium levels is warranted when these agents are used in combination. [145] Furthermore, in patients with hypertension plus type 2 diabetes and renal impairment who are at high risk of cardiovascular and renal events, there is an increased risk of nonfatal stroke, renal complications, hypokalemia, and hypotension when aliskiren is added to ACEI or ARB therapy.

Fosinopril

Fosinopril may be used alone or in combination with other antihypertensive agents. Initial dose is 5 mg daily up to a maximum of 40 mg daily. May be divided into twice daily dosing. Unlike most ACE inhibitors that are primarily excreted by the kidneys, fosinopril is eliminated by both renal and hepatic pathways, making it a safer choice in patients with renal failure and heart failure patients with impaired kidney function.

Captopril

Captopril is indicated for the treatment of hypertension. It can be used alone or in combination with other antihypertensive drugs, such as diuretics or beta-adrenergic-blocking agents. The initial dose is 25 mg given 2 to 3 times daily. If reduction of blood pressure is not achieved after 1 or 2 weeks, the dose can be titrated to 50 mg 2 or 3 times daily. If further blood reduction is required after addition of a diuretic, the dose of captopril may be increased to 100 mg 2 or 3 times daily and then, if necessary, to 150 mg 2 or 3 times daily (while continuing the diuretic).

Ramipril (Altace)

Ramipril is indicated for the treatment of hypertension alone or in combination with thiazide diuretics. The initial dosing recommendation for ramipril is 2.5 mg daily for patients who are not receiving a diuretic. Doses can range from 2.5-20 mg/day given once or twice a day.

Enalapril (Vasotec)

Enalapril is effective alone or in combination with other antihypertensive agents, especially thiazide-type diuretics. The initial dose of enalapril is 5 mg daily. Dosage can range from 10-40 mg/day administered as a single dose or in 2 divided doses.

Lisinopril (Prinivil, Zestril)

Lisinopril may be used as monotherapy or concomitantly with other classes of antihypertensive agents. The initial dose of lisinopril is 10 mg daily. The dosage can range from 20-40 mg/day as a single daily dose. Doses up to 80 mg/day have been used; however, they do not show a greater effect.

Quinapril (Accupril)

Quinapril may be used alone or in combination with thiazide diuretics. The initial dose is 10 to 20 mg daily for patients not on diuretics. If blood pressure is not controlled with quinapril monotherapy, adding a diuretic should be considered.


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