ACE Inhibitors: Congestive Heart Failure: Difference between revisions

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<div class="editorbox"> '''Original Editor '''- [[User:Lauren Pulliam Southern|Lauren Pulliam Southern] '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div>
<div class="editorbox"> '''Original Editor '''- [[User:User Name|Lauren Pulliam Southern]] '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div>


== Introduction ==
== Introduction ==
Angiotensin Converting Enzyme (ACE) Inhibitors are one of the drugs used to treat  [[Heart Failure|Congestive Heart Failure]] (CHF). They work by increasing [[Vasodilators in the Treatment of Hypertension|vasodilation]] and decreasing workload of the heart in patients with CHF.  
[[File:Heart failure.png|right|frameless|Heart Failure]]
[[Angiotensin Inhibitors and Blockers for Treating Hypertension|Angiotensin Converting Enzyme (ACE) Inhibitors]] are a important class of drugs used in the management of [[Cardiovascular Disease|cardiovascular]] and [[Chronic Kidney Disease|renal disease]]<nowiki/>s, including [[Heart Failure|Congestive Heart Failure]] (CHF), [[Acute Coronary Syndrome|acute coronary syndrome]], nephrotic syndrome, [[diabetes]], and [[hypertension]].


== Mode of Action ==
Using an angiotensin-converting enzyme (ACE) inhibitor drug is an important part of treating heart failure. ACE inhibitors are strongly recommended as first-choice therapy in patients with heart failure<ref>Herman LL, Padala SA, Annamaraju P, Bashir K. Angiotensin converting enzyme inhibitors (ACEI). StatPearls [Internet]. 2021 Jun 18.Available: https://www.ncbi.nlm.nih.gov/books/NBK431051/#!po=6.81818<nowiki/>(accessed 6.4.2022)</ref>.
ACE inhibitors prevent vasoconstriction by suppressing the angiotensin converting enzyme, preventing angiotensin I from converting into angiotensin II. Angiotensin converting enzyme is responsible for converting angiotensin I to angiotensin II which is responsible for vasoconstriction<ref>Montezano AC, Nguyen Dinh Cat A, Rios FJ, Touyz RM. Angiotensin II and vascular injury. ''Current Hypertension Reports''. 2014;16(6):431</ref>. In addition to being a powerful vasoconstrictor, Angiotensin II is also responsible for hypertrophy of vascular tissues and aldosterone secretion.  Hypertrophy of vascular tissues causes vessels to become narrow resulting in increased workload on the heart.  Aldosterone secretion is primarily responsible for water retention which can increase vascular fluid volume also increasing the workload on the heart. Therefore, the inhibition of angiotensin II decreases the amount of pressure in the heart which decreases workload on the heart<ref>Katragadda S, Arora RR. Role of angiotensin-converting enzyme inhibitors in vascular modulation: beyond the hypertensive effects. ''American Journal of Therapeutics.'' 2010;17(1):e11-23</ref>.  Another beneficial effect of ACE inhibitors is that they increase bradykinin levels in the blood by decreasing their breakdown.  Bradykinin is responsible for vasodilation<ref>Regoli D, Plante GE, Gobeil F Jr. Impact of kinins in the treatment of cardiovascular diseases. ''Pharmacology & Therapeutics''. 2012;135(1):94-111.</ref>.  
{{#ev:youtube|https://www.youtube.com/watch?v=xIlaQuRaZmk|width}}<ref>British Heart Foundation How do ACE inhibitors work? Available from: https://www.youtube.com/watch?v=xIlaQuRaZmk (last accessed 17.6.2019)</ref>


== Common Ace Inhibitors ==
== Effects ==
In general, these medications help decrease cardiac output by limiting vasoconstriction and inhibiting aldosterone secretion promoting vasodilation.Common ACE inhibitors for patients with CHF are    
[[File:Renin ang pathway 2.jpeg|right|frameless|434x434px]]
Angiotensin-converting enzyme inhibitors (ACEIs) improve heart failure by decreasing afterload, preload, and systolic wall stress, which results in increased cardiac output without any increase in [[Heart Rate|heart rate]]. 
 
ACE inhibitors play an important role in: 
 
* Promoting salt excretion by augmenting the renal [[Blood Physiology|blood]] flow and reducing [[Aldosterone Receptor Antagonist Diuretics in the treatment of congestive heart failure|aldosterone]] and antidiuretic hormone production.
* Reducing [[Muscle: Cardiac|cardiac myocyte]] hypertrophy (angiotensin II is also responsible for hypertrophy of vascular tissues)
* Increasing bradykinin levels in the blood by decreasing their breakdown.  Bradykinin is responsible for vasodilation.    


benazepril: given 10 mg once daily and gradually increased to 20-40 mg per day with a half-life of 10-11 hours and 12 hours respectively.  If given with a diuretic the initial dose should be 5mg<ref name=":1">U.S. Food and Drug Administration (FDA). Lotensin (benazepril hydrochloride). Available online at: <nowiki>https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/019851s042lbl.pdf</nowiki>. Last accessed 11/29/18.</ref><ref name=":2">U.S. Food and Drug Administration (FDA). MONOPRIL (fosinopril sodium tablets). Available online at: <nowiki>https://www.accessdata.fda.gov/drugsatfda_docs/label/2003/19915se5-037_monopril_lbl.pdf</nowiki>. Last accessed 11/29/18.</ref>.   
Since the 1980s, several large, prospective, randomized, placebo-controlled trials have proved that treatment with ACE inhibitors reduces overall mortality, especially in patients with heart failure with reduced ejection fraction.    


fosinopril: given 10 mg once daily and gradually increased to 20-40 mg per day with a half-life of 10-11 hours and 12 hours respectively.  If given with a diuretic the initial dose should be 5mg<ref name=":1" /><ref name=":2" />. 
== Common Ace Inhibitors ==
Several ACE inhibitors are on the market, and it is generally thought that they are equally beneficial in the treatment of heart failure. Commonly used ACE inhibitors include:  


captropil<ref name=":0">Ciccone CD. Renin Angiotensin System Inhibitors. ''Pharmacology in rehabilitation.'' 5th ed. Philadelphia: F.A. Davis Company; 2016</ref>: given 25 mg 3 times daily and has a shorter half-life of 3.3 hours requiring the patient to take it more frequently<ref>U.S. Food and Drug Administration (FDA). CAPOTEN® (Captopril Tablets, USP). Available online at: <nowiki>https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/018343s084lbl.pdf</nowiki>.  Last accessed 11/29/18.</ref>.  
* Accupril (quinapril)
* Altace (ramipril)
* Capoten (captopril)
* Mavik (trandalopril)
* Monopril (fosinopril)
* Vasotec (enalapril)
* Zestril (lisinopril)<ref>Very well health How ACE Inhibitors Treat Heart Failure Available:https://www.verywellhealth.com/ace-inhibitors-for-treating-heart-failure-4120575 (accessed 6.4.2022)</ref>


== Adverse Effects ==
== Implications for Physiotherapy ==
* Hypotension and Renal Failure because ACE inhibitors are primarily excreted through the kidneys. Rare
[[File:Syncope.jpeg|thumb|Syncope AKA Fainting, swooning]]
* minor side effects include: Angioedema (an area of swelling of the lower layer of skin and tissue just under the skin or mucous membranes skin)<ref>Wikipedia [https://en.wikipedia.org/wiki/Angioedema Angioedema] Available from: https://en.wikipedia.org/wiki/Angioedema (last accessed 17.6.2019)</ref>; Rashes; GI discomfort; Dizziness.” These are normally resolved with adjusting the dosage<ref name=":0" />.
ACE inhibitors cause a reduction in [[Blood Pressure|blood pressure]], this coupled with the naturally occurring post-exercise [[hypotension]] can result in excessive reductions in blood pressure. This can lead to dizziness and, in rare instances, syncope.  


== Physiotherapy - Implications ==
Post-exercising clients on ACE inhibitors may need education in adhering to a gradual cool-down after each and every exercise session to prevent these symptoms and benefit the body by enhancing venous return and the prevention of blood pooling in the [[Muscle|skeletal muscle]]. A gradual cool-down of five to 10 minutes of light [[Aerobic Exercise|aerobic]] activity allows the body to return to homeostasis and prevents excessive reductions in blood pressure.<ref>American Council of Exercise [https://www.acefitness.org/certifiednewsarticle/3296/how-common-medications-may-affect-your-clients/ How Common Medications May Affect Your Clients’ Exercise Programs] Available from: https://www.acefitness.org/certifiednewsarticle/3296/how-common-medications-may-affect-your-clients/ (last accessed 17.6.2019)</ref>
ACE inhibitors cause a reduction in BP this coupled with the naturally occurring post-exercise hypotension can result in excessive reductions in blood pressure. This can lead to dizziness and, in rare instances, syncope. Post exercising clients on ACE inhibitors educate re adhering to a gradual cool-down after each and every exercise session. This benefits the body by enhancing venous return and the prevention of blood pooling in the skeletal muscle. A gradual cool-down of five to 10 minutes of light aerobic activity allows the body to return to homeostasis and prevents excessive reductions in blood pressure.<ref>American Council of Exercise [https://www.acefitness.org/certifiednewsarticle/3296/how-common-medications-may-affect-your-clients/ How Common Medications May Affect Your Clients’ Exercise Programs] Available from: https://www.acefitness.org/certifiednewsarticle/3296/how-common-medications-may-affect-your-clients/ (last accessed 17.6.2019)</ref>
[[File:Hf.png|center|frameless|517x517px]]


== References ==
== References ==
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[[Category:Pharmacology]]  
[[Category:Pharmacology]]  
[[Category:Pharmacology for Cardiovascular Disease]]
[[Category:Pharmacology for Cardiovascular Disease]]
[[Category:Older People/Geriatrics]]

Latest revision as of 06:04, 6 April 2022

Original Editor - Lauren Pulliam Southern Top Contributors - Lucinda hampton, Lauren Pulliam Southern, Kim Jackson, Lauren Lopez, Beau Lawrence and Joseph Ayotunde Aderonmu

Introduction[edit | edit source]

Heart Failure

Angiotensin Converting Enzyme (ACE) Inhibitors are a important class of drugs used in the management of cardiovascular and renal diseases, including Congestive Heart Failure (CHF), acute coronary syndrome, nephrotic syndrome, diabetes, and hypertension.

Using an angiotensin-converting enzyme (ACE) inhibitor drug is an important part of treating heart failure. ACE inhibitors are strongly recommended as first-choice therapy in patients with heart failure[1].

Effects[edit | edit source]

Renin ang pathway 2.jpeg

Angiotensin-converting enzyme inhibitors (ACEIs) improve heart failure by decreasing afterload, preload, and systolic wall stress, which results in increased cardiac output without any increase in heart rate.

ACE inhibitors play an important role in:

  • Promoting salt excretion by augmenting the renal blood flow and reducing aldosterone and antidiuretic hormone production.
  • Reducing cardiac myocyte hypertrophy (angiotensin II is also responsible for hypertrophy of vascular tissues)
  • Increasing bradykinin levels in the blood by decreasing their breakdown.  Bradykinin is responsible for vasodilation.  

Since the 1980s, several large, prospective, randomized, placebo-controlled trials have proved that treatment with ACE inhibitors reduces overall mortality, especially in patients with heart failure with reduced ejection fraction.  

Common Ace Inhibitors[edit | edit source]

Several ACE inhibitors are on the market, and it is generally thought that they are equally beneficial in the treatment of heart failure. Commonly used ACE inhibitors include:

  • Accupril (quinapril)
  • Altace (ramipril)
  • Capoten (captopril)
  • Mavik (trandalopril)
  • Monopril (fosinopril)
  • Vasotec (enalapril)
  • Zestril (lisinopril)[2]

Implications for Physiotherapy[edit | edit source]

Syncope AKA Fainting, swooning

ACE inhibitors cause a reduction in blood pressure, this coupled with the naturally occurring post-exercise hypotension can result in excessive reductions in blood pressure. This can lead to dizziness and, in rare instances, syncope.

Post-exercising clients on ACE inhibitors may need education in adhering to a gradual cool-down after each and every exercise session to prevent these symptoms and benefit the body by enhancing venous return and the prevention of blood pooling in the skeletal muscle. A gradual cool-down of five to 10 minutes of light aerobic activity allows the body to return to homeostasis and prevents excessive reductions in blood pressure.[3]

Hf.png

References[edit | edit source]

  1. ↑ Herman LL, Padala SA, Annamaraju P, Bashir K. Angiotensin converting enzyme inhibitors (ACEI). StatPearls [Internet]. 2021 Jun 18.Available: https://www.ncbi.nlm.nih.gov/books/NBK431051/#!po=6.81818(accessed 6.4.2022)
  2. ↑ Very well health How ACE Inhibitors Treat Heart Failure Available:https://www.verywellhealth.com/ace-inhibitors-for-treating-heart-failure-4120575 (accessed 6.4.2022)
  3. ↑ American Council of Exercise How Common Medications May Affect Your Clients’ Exercise Programs Available from: https://www.acefitness.org/certifiednewsarticle/3296/how-common-medications-may-affect-your-clients/ (last accessed 17.6.2019)
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