Which medications in the drug class ACE Inhibitors are used in the treatment of Renovascular Hypertension?

Updated: Dec 01, 2020
  • Author: Rebecca J Schmidt, DO, FACP, FASN; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

ACE Inhibitors

ACE inhibitors have been used by some in the control of RVHT. These agents minimize an ischemia-induced rise in angiotensin production. Because hypertension may be dependent on angiotensin II, antihypertensives that inhibit renin or angiotensin II are used widely. All drugs in this class have similar action and adverse effects. In particular, ACE inhibitors increase the risk of decreased renal function. Although this increased risk is usually reversible, the use of these agents is generally avoided until definitive therapy has been attempted.

Renal blood flow is maintained by a balance between angiotensin-II–induced vasoconstriction and prostaglandin-mediated vasodilation. With ACE inhibitors, kidney perfusion is increased and renal vascular resistance decreased. ACE inhibitors induce vasodilation in both afferent and efferent arterioles. The glomerular filtration rate (GFR) generally increases. However, in hypoperfusion states (eg, renal artery stenosis (RAS), aggressive diuresis, and decompensated congestive heart failure), GFR may fall because of unopposed prostaglandin vasodilation.

Captopril

Captopril, the most commonly used ACE inhibitor, prevents conversion of angiotensin I to angiotensin II (a potent vasoconstrictor), resulting in lower aldosterone secretion. It is excreted primarily by the kidney.

Enalapril (Vasotec)

Enalapril is a competitive ACE inhibitor that reduces angiotensin II levels and decreases aldosterone secretion.

Lisinopril (Zestril, Prinivil)

Lisinopril prevents conversion of angiotensin I to angiotensin II, resulting in decreased aldosterone secretion.


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