ACE Inhibitor-Induced Angioedema: a Review

  • William J. KostisEmail author
  • Mrinali Shetty
  • Yuvraj Singh Chowdhury
  • John B. Kostis
Guidelines/Clinical Trials/Meta-Analysis (JB Kostis, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Guidelines/Clinical Trials/Meta-Analysis


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.


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.


Angiotensin II Angioedema Angiotensin-converting enzyme inhibitors Hypertension Bradykinin 


Compliance with Ethical Standards

Conflict of Interest

The authors declare no conflict of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

No human or animal data were collected in writing this review.


Papers of particular interest, published recently, have been highlighted as: • Of importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • William J. Kostis
    • 1
    Email author
  • Mrinali Shetty
    • 2
  • Yuvraj Singh Chowdhury
    • 2
  • John B. Kostis
    • 1
  1. 1.Rutgers Robert Wood Johnson Medical SchoolCardiovascular InstituteNew BrunswickUSA
  2. 2.Saint Peter’s University HospitalNew BrunswickUSA

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