ACE Inhibitor-Induced Angioedema: a Review

William Kostis, Mrinali Shetty, Yuvraj Singh Chowdhury, John Kostis

Research output: Contribution to journalReview articlepeer-review

17 Scopus citations

Abstract

Purpose of Review: This study aims to examine current knowledge on the occurrence, pathophysiology, and treatment of angioedema among patients who receive angiotensin-converting enzyme inhibitors. Recent Findings: Angiotensin-converting enzyme inhibitors (ACE-I), a medication class used by an estimated 40 million people worldwide, are associated with angioedema that occurs with incidence ranging from 0.1 to 0.7%. The widespread use of ACE-I resulted in one third of all emergency department visits for angioedema. Angioedema occurs more frequently in African Americans, smokers, women, older individuals, and those with a history of drug rash, seasonal allergies, and use of immunosuppressive therapy. The pathophysiology of ACE-I-induced angioedema involves inhibition of bradykinin and substance P degradation by ACE (kininase II) leading to vasodilator and plasma extravasation. Treatment modalities include antihistamines, steroids, and epinephrine, as well as endotracheal intubation in cases of airway compromise. Patients with a history of ACE-I-induced angioedema should not be re-challenged with this class of agents, as there is a relatively high risk of recurrence. Conclusion: ACE-I are frequently used therapeutic agents that are associated with angioedema. Their use should be avoided in high-risk individuals and early diagnosis, tracheal intubation in cases of airway compromise, and absolute avoidance of re-challenge are important.

Original languageEnglish (US)
Article number55
JournalCurrent Hypertension Reports
Volume20
Issue number7
DOIs
StatePublished - Jul 1 2017

All Science Journal Classification (ASJC) codes

  • Internal Medicine

Keywords

  • Angioedema
  • Angiotensin II
  • Angiotensin-converting enzyme inhibitors
  • Bradykinin
  • Hypertension

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