Angiotensin Converting Enzyme Inhibitors

ACE inhibitors prevent the conversion of angiotensin I to angiotensin II by angiotensin converting enzyme (ACE) in the lungs, in turn reducing effects of angiotensin II. These effects include:

  • Vasoconstriction
  • Noradrenaline reuptake inhibition
  • Thirst
  • ADH release
  • ACTH release
  • Aldosterone release
  • Reduces Kf, reducing GFR


  • Hypertension
    • Particularly in insulin dependent diabetes with diabetic nephropathy
    • Less effective for this indication in the black population
    • Contribute to post-operative hypertension and may be withheld perioperatively
  • Cardiac failure
    All grades.
  • MI with LV dysfunction
    Improved prognosis.


Can be divided into three groups based on pharmacokinetics:

  • Active drug with active metabolites
  • Prodrug
  • Not metabolised and excreted unchanged in urine

Common Features of ACE Inhibitors

Property Drug
Resp Bradykinin cough
CVS SVR and BP. Unaffected HR and baroreceptor response.
Endocrine Hypoglycaemia in diabetics
Renal With a normal renal perfusion pressure, natriuresis results. However, a fall in renal perfusion pressure may cause pre-renal failure (e.g. renal artery stenosis).
Haeme Agranulocytosis, thrombocytopenia
Immune Angioedema
Metabolic ↑ Renin release.
Interactions ↓ Aldosterone release, which ↑ the efficacy of spironolactone and may precipitate hyperkalaemia. Pharmacodynamic interaction with NSAIDs to drop renal perfusion pressure.


  1. Peck TE, Hill SA. Pharmacology for Anaesthesia and Intensive Care. 4th Ed. Cambridge University Press. 2014.
Last updated 2019-11-02

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