Cardiovascular

ACE Inhibitors

Cardiovascular

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lisinoprilenalaprilcaptopril

Prefix / Suffix: -pril

Physiology

ACE inhibitors act on the renin–angiotensin–aldosterone system (RAAS). Angiotensin II normally causes vasoconstriction and stimulates aldosterone, leading to sodium and water retention. By reducing angiotensin II, these drugs promote vasodilation and reduce fluid volume.

Mechanism of Action

They inhibit the angiotensin-converting enzyme, preventing the formation of angiotensin II. This leads to vasodilation, decreased aldosterone secretion, and reduced blood pressure.

Indications

  • Hypertension
  • Heart failure
  • Myocardial infarction
  • Diabetic nephropathy
  • Chronic kidney disease

Side Effects / Adverse Effects

  • Dry cough (due to bradykinin accumulation)
  • Hypotension (due to vasodilation)
  • Hyperkalemia (due to reduced aldosterone causing potassium retention)
  • Angioedema (due to increased bradykinin; can block airway)
  • Renal impairment (especially in renal artery stenosis)

Contraindications

  • Pregnancy
  • History of angioedema
  • Bilateral renal artery stenosis
  • Severe hyperkalemia

Nursing Considerations

  • Monitor blood pressure, especially after first dose (risk of first-dose hypotension, more common if patient is on diuretics or dehydrated)
  • Check serum potassium levels regularly (ACE inhibitors reduce aldosterone, increasing risk of hyperkalemia and cardiac complications)
  • Monitor renal function—urea and creatinine (drug can reduce glomerular filtration, especially in renal artery stenosis)
  • Assess for persistent dry cough (common side effect that may require switching to ARBs)
  • Observe for signs of angioedema such as facial or tongue swelling (medical emergency due to airway obstruction)
  • Avoid potassium supplements and potassium-containing salt substitutes (to prevent worsening hyperkalemia)
  • Advise patient to rise slowly (to reduce dizziness from hypotension)

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