ACE Inhibitors
Examples: lisinopril, enalapril, and captopril
Action: decreases peripheral vascular resistance to decrease blood pressure; indicated for heart failure and hypertension
Side effects: postural hypotension, dizziness, nonproductive cough, angioedema, kidney injury, and hyperkalemia
Nursing considerations: (1) assess patient for history of renal impairment, as ACE inhibitors may exacerbate kidney injury; (2) teach patient to seek immediate medical attention if he/she experiences swelling of the lips (angioedema; as pictured), as severe angioedema may cause respiratory distress; (3) teach patient to notify HCP if a nagging cough develops
Also of note: ACE inhibitors are contraindicated during second- and third-trimester pregnancies
My clinical experience:
(1) Angioedema with ACE inhibitor use is quite common, especially with African Americans and may not manifest itself for months/years after starting an ACE inhibitor.
(2) In light of acute kidney injury, doctors do often suspect fault with ACE Inhibitors and will hold/discontinue medications as appropriate.
(3) A patient with a nonproductive cough, another common complication, although certainly not an immediate concern, will likely be switched to another class of medication.
(4) Remember, when heart failure arises, the goal is to DECREASE the WORK LOAD of the heart in any way. ACE inhibitors accomplish this by decreasing RESISTANCE of blood against arterial walls, thus increasing CARDIAC OUTPUT.
