ACE Inhibitor-Induced Angioedema: a Review

• Published in: Current hypertension reports Vol. 20; no. 7; pp. 55 - 7
• Main Authors: Kostis, William J., Shetty, Mrinali, Chowdhury, Yuvraj Singh, Kostis, John B.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-07-2018; Springer Nature B.V
• Subjects: ACE inhibitors; Angioedema; Cardiology; Diuretics; Edema; Enzymes; Family Medicine; General Practice; Guidelines/Clinical Trials/Meta-Analysis (JB Kostis; Hypertension; Internal Medicine; Intubation; Medicine; Medicine & Public Health; Metabolic Diseases; Nephrology; Primary Care Medicine; Section Editor; Topical Collection on Guidelines/Clinical Trials/Meta-Analysis; Angiotensin-converting enzyme inhibitors; Hypertension; Angiotensin II; Angioedema; Bradykinin
• ISSN: 1522-6417; 1534-3111
• DOI: 10.1007/s11906-018-0859-x

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.