When the other participation criteria of the trial were applied, 246 patients were excluded because they failed to reach the target dose of an ACE inhibitor
or ARB, while another 60 were excluded for other reasons.
However, in patients taking ACE inhibitors
or ARBs for hypertension, increasing potassium intake must be approached with caution because of the potential for these drugs to cause hyperkalemia.
A 2011 meta-analysis of 5 RCTs (total 2975 patients) that compared ACE inhibitor
therapy with placebo in diabetic patients without hypertension and albuminuria found that ACE inhibitors
reduced the risk of new-onset microalbuminuria or macroalbuminuria by 18% (relative risk [RR]=0.82; 95% confidence interval [CI], 0.73-0.92).
The mainstay of management is to secure the airway, discontinue the ACE inhibitor
, and give systemic steroids.
"The smokers had a faster decline in kidney function over time than the nonsmokers and the subjects who quit smoking [and] our continued smokers actually had an increase in albuminuria despite being placed on an ACE inhibitor
Angiotensin II receptor blockers (ARBs) provide many of the same benefits of ACE inhibitors
and may be an alternative for people who cannot tolerate ACE inhibitors
ACE (angiotensin-converting enzyme) inhibitors prevent the body from making ACE, which converts a naturally occurring chemical called angiotensin I into angiotensin II.
(13) The ACE inhibitor
should be discontinued, and the patient should be started on a different class of antihypertensive medication.
Also, the percentage of patients who withdrew from ACE inhibitor
therapy due to cough from enalapril was higher in the study (2.57 percent) than indicated in the PDR/label (0.1 percent).
And it was better than an ACE inhibitor
in preventing stroke and heart disease.
In 2002 researchers reported that among patients followed for four to eight years the diuretic was better than the calcium channel blocker in preventing heart failure and better than the ACE inhibitor
in preventing stroke, heart failure and overall cardiovascular disease.
The concern arises when patients are taking an ACE inhibitor
, which is a kininase II blocker and will inhibit the catabolism of bradykinin.
"If there is an indication for an ACE inhibitor
, we might as well use one that crosses the blood-brain barrier," Dr.
The ACE inhibitor
ramipril (Hoechst's Altace) or the beta-blocker metoprolol (Astra's Toprol) significantly reduced the risk of kidney failure compared to the CCB amlodipine (Pfizer's Norvasc) in a group of patients who had at last one gram of protein in a 24-hour sample of urine upon entrance to the African American Study of Kidney Disease and Hypertension (AASK), an ongoing study that has enrolled 1100 patients at 21 US centers.