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As a class of drugs which is efficient in blocking the activity of the ACE enzyme, ACE inhibitors cause blood vessels to dilate. How effective are they in the treatment of coronary artery disease?

ACE (short for “angiotensin-converting enzyme”) inhibitors are a class of drugs that dilate the blood vessels, facilitating blood flow. They are useful in treating conditions such as elevated blood pressure or coronary artery disease, both conditions being a consequence of narrow blood vessels.

The role of ACE inhibitors

The body naturally produces a chemical known as angiotensin II, which travels through the bloodstream. The major effect of this powerful chemical is to cause the muscles of the arteries to contract, forcing them to become narrower.

This leads to two main problems:

  • When the walls of the arteries become narrow, the pressure that blood exerts in order to reach its destination is stronger. By applying more and more pressure on the artery wall, their inner lining gets damaged in time, leading to a lot of different coronary artery problems (note that high blood pressure can affect all arteries inside the body, not just the ones leading to the heart).
  • As the walls of the arteries are narrower, less blood is able to travel through them, which means that the heart isn’t receiving the normal amount of blood and oxygen. As a consequence, the heart starts beating faster, because it is looking to draw in more blood and compensate for the “lost” amount. The result is a weakening of the muscles of the heart, which leads to a number of other heart-related complications.

The body has an enzyme called angiotensin converting enzyme, which causes the angiotensin I in the blood to form angiotensin II. By taking ACE inhibitors, you are acting against the activity of the ACE enzyme, making it less efficient in producing angiotensin II.

ACE inhibitors are a major part in the treatment of hypertension, which is one of the risk factors for coronary artery disease. When you have elevated blood pressure, the heart has to work harder in order to pump more blood, making up for the losses caused by narrow arteries.

Hypertension can also lead to atherosclerosis. As blood pressure exerts more force on the inner lining of the artery walls, this tissue become weaker and will eventually suffer damage. As this damage occurs, fatty deposits are more likely to find their way onto the artery walls, causing plaque build-up.

One of the major consequences of plaque build-up is coronary artery disease, which means that high blood pressure triggers a chain reaction that leads to heart problems.

While there are many different types of ACE inhibitors, the body processes them differently. Some are absorbed real quick, while others are eliminated faster from the body. Depending on this particular factor, some ACE inhibitors should only be taken once a day, while others require multiple doses.

Additionally, there are ACE inhibitors that will only work once they are converted into an active form, and there are also some that are more efficient on tissue ACE rather than bloodstream ACE. It has yet to be determined which ACE inhibitors are better than others, so doctors will have to look at each individual patient case before prescribing one.

ACE inhibitors: Side effects

ACE inhibitors are a class of strong drugs, which means that certain people might be sensitive to the active substances used in the recipe. While most side effects are normal, it’s important to know what to expect when you’re starting medical treatment with a new drug.

The most common side effects of starting an ACE inhibitor-based treatment include cough, dizziness or headaches, a drop in blood pressure, a sense of fatigue and irritability, chest pain, skin rashes, a salty or metallic taste, an increase in potassium levels, and increased levels of uric acid.

In very rare cases, ACE inhibitors can lead to a series of threatening side effects, which are less common. They include pancreatitis, kidney failure, liver dysfunction, tissue swelling, or allergic reactions.

ACE inhibitors: Drug interactions

It’s always important to talk to your doctor about other medication you may be taking if they plan to put you on an ACE inhibitor. Interactions to look out for include:

  • ACE inhibitors should not be taken at the same time as ARBs, because this leads to an increase in blood pressure and hyperkalemia.
  • It is also believed that ACE inhibitors may be less efficient when taking them in combination with anti-inflammatory drugs, like ibuprofen, indomethacin, naproxen, or aspirin.
  • One of the main side effects of ACE inhibitors is an increase in blood levels of potassium and lithium. Because of that, ACE inhibitors should not be taken together with potassium supplements.
  • ACE inhibitors combined with injectable gold sodium aurothiomalate (part of the treatment plan of rheumatoid arthritis) can cause nitroid reactions, such as low blood pressure, vomiting, and flushing.
  • Diuretics may also interact with ACE inhibitors, by causing blood pressure to drop. the best way around this is to either stop taking the diuretic before starting the ACE inhibitor treatment (but only if the doctor says it’s OK), or increase the salt intake before taking the inhibitor. Patients who can’t stop taking diuretics should be closely monitored in the first hours after having taken the first ACE inhibitor, to make sure that blood pressure is stable.
  • You might also want to avoid taking ACE inhibitors with aliskiren. This is a class of drugs used to treat hypertension, but when combining it with an ACE inhibitor, you risk ending up with hyperkalemia, kidney failure, or very low blood pressure levels.

Conclusion

As a class of drugs which is efficient in blocking the activity of the ACE enzyme found inside the body, ACE inhibitors cause blood vessels to dilate. The primary purpose of ACE inhibitors is to regulate high blood pressure, which can lead to damage of the inner lining of the coronary artery walls.

ACE inhibitors have an indirect role in helping people with coronary artery disease caused by elevated blood pressure. Because hypertension leads to the formation of plaques that are responsible for atherosclerosis, their effect can also prevent coronary artery disease.

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