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ACE Inhibitor-Induced Angioedema: a Review

  • Guidelines/Clinical Trials/Meta-Analysis (JB Kostis, Section Editor)
  • Published:
Current Hypertension Reports Aims and scope Submit manuscript

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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Correspondence to William J. Kostis.

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

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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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