ACE inhibitors in hypertension

ACE inhibitors are antihypertensive drugs. They are also used in the management of heart failure and chronic kidney disease.

Indications for the use of ACE inhibitors in the treatment of hypertension include:

• compelling indications - heart failure, left ventricular dysfunction
• possible indications - chronic renal disease*, type II diabetic nephropathy

Contraindications for the use of ACE inhibitors in the treatment of hypertension include:

• compelling contraindications - pregnancy, renovascular disease
• possible contraindications - renal impairment*, peripheral vascular disease**

ACE inhibitors are less effective when renin levels are low, most commonly seen in Afro-Caribbean hypertensive patients.

* ACE inhibitors may be beneficial in chronic renal failure but should be used with caution. Close supervision and specialist advice are needed when there is established and significant renal impairment.

** caution with ACE inhibitors and angiotensin II receptor antagonists in peripheral vascular disease because of association with renovascular disease.