Risk and Benefits of ACE Inhibitor and Calcium Channel Blocker in Hypertension Treatment

Risk and benefits of ACE inhibitor and Calcium Channel blocker in the treatment of
hypertension
Angiotensin-Converting Enzyme Inhibitors (ACEIs) and calcium channel blockers
(CCBs) are administered to hypertensive patients with the objective of reducing their elevated
blood pressure and improving the cardiovascular outcomes. This essay discusses the benefits,
risks and treatment outcomes in hypertensive patients in the context of evidence-based
findings.
Angiotensin-Converting Enzyme Inhibitors (ACEIs) effectively influence the level of
body’s hormones with the objective of effectively controlling the systolic and diastolic blood
pressure. They block the angiotensin converting enzyme with the objective of reducing the
production of angiotensin (1). ACE inhibitors are highly recommended for controlling the
primary blood pressure elevation in hypertensive adults. ACE inhibitors obstruct the renin-
angiotensin-aldosterone mechanism. Their activity does not reciprocate in accordance with
the renin level (2). ACEIs effectively challenge the generation of angiotensin II from
angiotensin I by directly inhibiting the angiotensin converting enzyme. The reduction in the
production of angiotensin II leads to blood pressure reduction and natriuresis (2). The
administration of ACEIs also reduces the remodelling pattern of cardiac myocytes and
smooth muscle. The reduction in venous and arterial blood pressure results in the reciprocal
decrease in afterload and preload. ACEIs also reduce the deterioration of the vasodilator
bradykinin that further assists in controlling the abnormal elevation in the systolic and
diastolic blood pressure (2).
ACE inhibitors are majorly prescribed for effectively controlling the cases of primary
hypertension where the systolic and diastolic blood pressure exceed 140mmHg and 90mmHg
(3). The ACE inhibitors exhibit adverse cardiovascular outcomes in black patients who
experience hypertensive manifestations (4). ACE inhibitors exhibit the potential of their

utilization in the cases of systolic heart failure in the form of adjunctive therapy. They rectify
the fluctuation in blood pressure while concomitantly restoring the left ventricular ejection
fraction (5). They are highly recommended for patients who have had a history of myocardial
infarction and experience high risk of developing the pattern of heart failure. In routine
scenarios, ACE inhibitors are substantially utilized for treating the hypertensive episodes
either singly or with other antihypertensive medications. ACE inhibitors evidentially control
the blood pressure elevation in patients of less than 60 years of age and diastolic blood
pressure of greater than 90mmHg (5). The therapeutic goal of administering the ACE
inhibitors attributes to the acquisition of systolic blood pressure below 140mmHg and
diastolic blood pressure below 90mmHg (5). Patients who acquire the age of more than 18
years, experience a clinical history of diabetes and develop a diastolic blood pressure of more
than 90mmHg also prove to be the candidates of ACEI therapy.
The therapeutic goal in this scenario attributes to the systolic blood pressure reduction
below 140mmHg and diastolic blood pressure reduction of less than 90mmHg. Patients of
age greater than 18 years, clinical history of chronic kidney disease, systolic blood pressure
of more than 140mmHg and diastolic blood pressure of less than 90mmHg appear to be the
candidates of ACEI therapy (5). The therapeutic goal in their case attributes to the reduction
of systolic blood pressure below 140mmHg and diastolic blood pressure below 90mmHg (5).
ACE inhibitors are the treatment of choice to restore kidney functionality irrespective of the
diabetic status of the hypertensive patients. ACE inhibitors are also recommended for
hypertensive non-black patients who exhibit the history of diabetes and do not develop its
chronic kidney disease (CKD) manifestation (5). However, black people who exhibit a
clinical history of diabetes with the existence of CKD require the administration of calcium
channel blockers (rather than ACEI) for controlling their hypertensive manifestation. Patients

who exhibit a history of coronary artery disease with hypertension require ACEI therapy for
effectively controlling their symptomatology (5).
Patients who concomitantly experience the co-morbid states (attributing to CKD,
diabetes, left ventricular dysfunction, history of chronic stable angina and hypertension)
require the administration of ACEI therapy for their symptom stabilization (5). Hypertensive
patients who develop STEMI (ST-elevated myocardial infarction) require the administration
of ACEI within 24 hours of the occurrence of the MI episode. Patients who reportedly exhibit
ejection fraction of less than 40%, cardiac arrest and anterior MI also require ACEI therapy
for their hypertension management (5). ACE inhibitors prove efficacious in post-AMI and
CHF scenarios due to their bradykinin protection property (6). Their cardioprotective effect
makes them the treatment of choice for patients who experience an elevated risk of
developing cardiovascular complications with age advancement. ACE inhibitors reduce the
risk of development of pneumonia in patients who exhibit the clinical history of a
cerebrovascular accident. ACE inhibitors include the drugs like quinapril, lisisnopril,
fosinopril, enalapril, captopril and ramipril (7).
ACE inhibitors elevate the serum potassium level, thereby facilitating the
development of hyperkalemia (8). The other adverse effects of ACEI include dizziness,
hypotension, elevated creatinine/BUN and syncope. ACE inhibitors are known to cause renal
failure, anuria, reduced fetal kidney function and oligohydramnios in pregnant women.
Therefore, they are highly contraindicated for their utilization by pregnant women (5). ACEIs
are also contraindicated for patients who experience hypersensitivity to their administration.
Patients who exhibit the pattern of angioedema following a previously administered dose of
ACEIs or develop any kind of hereditary or idiopathic edema should also refrain from the
utilization of ACEIs in relation to their associated adversities (5). Patients with a history of a