Angiotensin converting enzyme (ACE) inhibitors, a type of blood pressure medication, are usually well tolerated, but one of their rare side effects is angioedema.
Angiotensin converting enzyme (ACE) inhibitors are medications for managing high blood pressure. They are used to help prevent or treat many different types of conditions, including heart disease, kidney disease, and diabetes.
Although ACE inhibitors are generally well tolerated, they can cause some side effects, including — in rare cases — a condition known as angioedema. This refers to swelling due to a buildup of fluids deep within the skin. The swelling is typically not itchy, like hives, but may be painful.
Learn how ACE inhibitors can cause angioedema and what to expect if this side effect occurs.
Angioedema due to ACE inhibitors is believed to be caused by these medications’ effects on a molecule known as bradykinin. For this reason, it is sometimes called
Bradykinin plays many roles in the body, including the dilating and contracting of blood vessels. Its activity is typically controlled by the ACE protein, which helps break bradykinin when it’s not needed.
During treatment with ACE inhibitors, bradykinin can increase, which can cause blood vessels to become leaky. Fluid may leak out of the vessels into the surrounding tissues, causing mild to severe swelling in the affected areas.
Angioedema is an uncommon side effect of ACE inhibitor treatment, occurring in an estimated
However, some individuals may be more at risk of these side effects. For instance, certain genetic variants that affect bradykinin activity have been linked to an increased likelihood of developing angioedema with ACE inhibitor treatment.
Angioedema can develop at any point after starting ACE inhibitor treatment.
Most reactions typically occur within the first few weeks or months of starting treatment. Severe reactions may be more likely to start within the first few hours of the initial dose.
However, the first episodes of angioedema haven’t been reported until several years after starting ACE inhibitor therapy. In these cases, it may be unclear whether angioedema occurs due to ACE inhibitor treatment or if there is another cause of these symptoms.
Later onset cases of angioedema (at or longer than 6 weeks after starting ACE inhibitor therapy) have been reported in about
Angioedema relating to ACE inhibitors most often affects the head and neck, including the face and oral cavity. If the airways are affected, it can cause serious issues such as difficulty breathing. Left untreated, obstruction of the airways from swelling can be life threatening.
Symptoms can develop quickly — over just a couple of hours — and may last 2 to 3 days if left untreated. If you take ACE inhibitors and notice swelling — particularly in the face, neck, or mouth — it’s important to stop treatment and contact a healthcare professional right away. In some cases, hospitalization may be needed to manage symptoms and prevent severe consequences.
In addition to careful monitoring of oxygen levels and breathing, management of ACE inhibitor-induced angioedema may involve:
- oxygen supplementation
- antihistamines
- epinephrine
- steroids
- intubation
- surgical intervention, if the airway is too obstructed to intubate
ACE inhibitors are an important part of many treatment plans, including for those with serious heart and kidney conditions. These medications should not be continued or restarted in people who experience edema. Alternative treatments may need to be considered to help maintain or achieve blood pressure control.
Angiotensin 2 receptor blockers (ARBs) are commonly used in place of ACE inhibitors, especially for people who experience angioedema. These medications do not affect the activity of the ACE protein, so they are not expected to affect bradykinin levels like ACE inhibitors do.
Many individuals are able to switch to an ARB after experiencing angioedema with ACE inhibitor treatment. However, ARB-associated angioedema has been reported as well. The frequency or cause of these side effects isn’t clear, though they appear to be less common than with ACE inhibitors.
People who switch to an ARB after angioedema with ACE inhibitor therapy need careful monitoring for similar effects. Treatments such as antihistamines or epinephrine may be prescribed as a protective measure to be taken if symptoms develop.
Other blood pressure treatments, such as beta-blockers, may also be considered.
ACE inhibitors are important medications used to manage blood pressure. In rare cases, angioedema can develop as a result of ACE inhibitor treatment and can cause serious or potentially life threatening consequences.
Angioedema can develop at any point, even several years after beginning ACE inhibitor therapy. If you are taking an ACE inhibitor and experience atypical swelling — particularly of the face, mouth, or throat — it’s important to contact a healthcare professional right away.