23 July 2007
ACEIs are effective in lowering BP. They are
generally well tolerated and do not have adverse effects on lipid and
glucose metabolism. Their safety profile is good. Their benefits have
been demonstrated in certain groups of patients beyond BP reduction.
ACEIs have been shown to reduce mortality and morbidity in patients
with congestive heart failure and in post myocardial infarction
patients with reduced left ventricular ejection fraction. In patients
at increased cardiovascular risk, ACEIs have been shown to reduce
morbidity and mortality.
In the diabetic patient, ACEIs have
been shown to reduce cardiovascular mortality; to prevent the onset of,
as well as reduce proteinuria; and retard the progression of renal
disease. ACEIs have also been shown to reduce proteinuria and retard
progression of non-diabetic renal disease.
include cough and, rarely, angioedema. In patients with renovascular
disease or renal impairment, deterioration in renal function may occur.
If there is a rise of serum creatinine of more than 30% from baseline
within one to two weeks, ACEIs should be stopped.
increase foetal and neonatal mortality and therefore are
contraindicated in pregnancy and should be avoided in those planning
| ACEIs||Starting Dose||Recommended Maximum Dose|
| Captopril|| 25 mg|| 150 mg|
| Enalapril||5 mg|| 40 mg|
| Fosinopril|| 10 mg|| 40 mg|
| Lisinopril|| 5 mg|| 40 mg|
| Perindopril|| 2 mg|| 8 mg|
| Quinapril|| 5 mg|| 40 mg|
| Ramipril|| 2.5 mg||10 mg|
Table 15: ACEIs commonly used for the treatment of hypertension in Malaysia.
Clinical Practice Guidelines on the Management of Hypertension