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ACE Inhibitors

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.

Adverse effects 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.

ACEIs may increase foetal and neonatal mortality and therefore are contraindicated in pregnancy and should be avoided in those planning pregnancy.

ACEIsStarting DoseRecommended Maximum Dose
Captopril 25 mg 150 mg
Enalapril5 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 mg10 mg

Table 15: ACEIs commonly used for the treatment of hypertension in Malaysia.

Reference
Clinical Practice Guidelines on the Management of Hypertension


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