As such, simply switching from one ACE inhibitor to another will not alleviate the side effect per se. In most instances, a lessthan‐rigorous trial design proves to be the unmaking of a superiority claim for one ACE inhibitor (over another) for less frequent cough. The concept of an intraclass switch to alleviate a side effect has been most commonly applied to the issue of ACE inhibitor‐related cough. Most ACE inhibitor side effects can be viewed as a class effect. As of yet, the available information is less than convincing that ARBs are better tolerated than ACE inhibitors relative to physiologic side effects.Īlthough certain ACE inhibitor side effects can prove life threatening (such as angioedema) the majority fall into the category of being no more than discomforting however, in certain instances, ACE inhibitor side effects (such as a suppression in red blood cell production in the setting of erythrocytosis) can prove beneficial. Alternatively, with the ready availability of a drug class such as the angiotensin‐receptor blockers (ARBs), which offer similar benefits for both blood pressure (BP) control and event protection, the decision is simplified as to how long to tolerate a non‐physiologic side effect such as cough. The science behind ACE inhibitor use is well accepted, the art, however, is a work in progress, with many subtleties to use that only become evident after extensive usage experience.īoth physiologic and non‐physiologic side effects can be the basis for ACE inhibitor intolerance however, what constitutes true ACE inhibitor intolerance is highly subjective, and even when extreme physiologic change (such as an excessive increase in serum creatinine concentration) is the basis for drug discontinuation, there are differing opinions on when to stop (and/or restart) a medication in this class. There remains an art as much as a science to the use of these drugs. ACE inhibition is a sufficiently well accepted treatment modality, and most of the guidelines addressing treatment of hypertension, renal disease, and/or cardiovascular disease have this therapeutic option prominently positioned in the treatment hierarchy.ĭespite the universality of such recommendations, issues remain as to how to most safely utilize these compounds.
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