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ACE Inhibitor-Induced Angioedema: a Review

Current Hypertension Reports volume 20, Article number: 55 (2018) Cite this article

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.

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Authors and Affiliations

  1. Rutgers Robert Wood Johnson Medical School, Cardiovascular Institute, 125 Paterson Street, CAB-4100, New Brunswick, NJ, 08901, USA

    William J. Kostis & John B. Kostis

  2. Saint Peter’s University Hospital, New Brunswick, NJ, USA

    Mrinali Shetty & Yuvraj Singh Chowdhury

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  1. William J. Kostis
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  2. Mrinali Shetty
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  4. John B. Kostis
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Correspondence to William J. Kostis.

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This article is part of the Topical Collection on Guidelines/Clinical Trials/Meta-Analysis

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Kostis, W.J., Shetty, M., Chowdhury, Y.S. et al. ACE Inhibitor-Induced Angioedema: a Review. Curr Hypertens Rep 20, 55 (2018). https://doi.org/10.1007/s11906-018-0859-x

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Keywords

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