Angiotensin-converting enzyme inhibitor-related angioedema: how to deal with it

Abstract

Angiotensin-converting enzyme inhibitor-related angioedema is a well documented condition, which seems to occur in up to 1% of treated patients. It represents a problem for both the clinician and the patient: for the clinician, the diagnosis may be difficult due to its peculiar clinical characteristics, whereas for the misdiagnosed patient the delay prolongs a potentially dangerous situation. If the drug is not discontinued, the attacks tend to become worse and even life-threatening. There are now evidences that increased levels of bradykinin have an important role in the pathophysiology of attacks and, moreover, there are genetic factors that render certain individuals susceptible to angiotensin-converting enzyme inhibitor-related angioedema. In this review, the authors analyse the pathogenetic mechanism, the clinical presentation, the management and future perspectives of research on this condition.

A new approach for identification of novel antihypertensive peptides from egg proteins by QSAR and bioinformatics

“…ACE converts angiotensin I to angiotensin II, a potent vasoconstrictor; ACE also inactivates bradykinin, a potent vasodilator. Thus, inhibition of ACE may lead to blood pressure reduction and ACE inhibitory drug is clinically used as the first line therapy for hypertension (Beltrami & Zingale, 2006). Although synthesized antihypertensive drugs targeting inhibition of ACE have proven successful in lowering high blood pressure, synthetic drug medications for hypertension are believed to be associated with certain adverse side effects such as cough and angioedema (Beltrami & Zingale, 2006).…”

Arzneimittelassoziierte Angioödeme

“…Bei einer Hemmung von ACE erfolgt die Degradierung primär durch DPP-IV [25,34,35]. [4,37,38]. Häufig betreffen sie das Gesicht, die Lippen oder die Zunge [39] und verlaufen mild, also ohne eine Verlegung der Atemwege [11].…”

“…Klinisch imponieren Angioödeme entsprechend ihrer Lokalisation mit zum Teil massiven prallelastischen Schwellungen, Atemnot (bei Lokalisation im Hals) oder unspezifischen Magen-DarmKrämpfen. Todesfälle durch Erstickungen kommen vor [3,4]. Das klinische Erscheinungsbild "Angioödem" kann im Rahmen verschiedener Erkrankungen auftreten.…”

Endogenous Vasoactive Peptides

“…RAS blockers (ACE, ARBs) are renal protective that could be mediated through the action of bradykinin on B2 receptors [632]. The unwanted effect angioedema, swelling around the eyes, feet, lips, and throat, is thought to be mediated by increases of circulating levels of bradykinin [633][634][635]. Omapatrilate, a vasopeptidase inhibitor, was originally thought to be a potent selective ACE and NEP inhibitor.…”