ACE Inhibitor Controversies

Part of the Contemporary Cardiology book series (CONCARD)


  • Angiotensin-converting enzyme (ACE) inhibitors have been shown in large randomized controlled trials (RCTs) to prevent cardiovascular disease (CVD) outcomes significantly in patients with hypertension and heart failure (HF) and in patients with acute myocardial infarction (MI) with left ventricular (LV) dysfunction. Several recent RCTs including Condesartan in Heart Failure Assessment of Reduction in Mortality and Morbidity (CHARM) (1) and Valsartan in Acute Myocardial Infarction Trial (VALIANT) (2) have proved the equivalence of ACE inhibitors and angiotensin II receptor blockers (ARBs). Their adverse effects, however, deserve careful scrutiny if we are to give patients medications that have a lower adverse effect profile.

  • ACE inhibitors cause cough in more than 15 % of treated individuals and, most important, produce a significantly higher incidence of angioedema versus ARBs; this incidence is much higher in patients of African origin. Deaths owing to angioedema have been reported in several hypertension RCTs.


Aldosterone Antagonist Prevent Heart Attack Trial Endpoint Reduction RAAS Blockade Preserve Left Ventricular Systolic Function 
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Suggested Reading

  1. Jhund P, McMurray JJV. Does aspirin reduce the benefit of an angiotensin-converting enzyme inhibitor?: Choosing between the Scylla of observational studies and the Charybdis of subgroup analysis. Circulation 2006;113:2566–2568.PubMedCrossRefGoogle Scholar

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© Humana Press Inc., Totowa, NJ 2007

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