ACEIs in high blood pressure: friend or enemy?

Abstract

Optimal blood pressure control has been one of the fundamental objectives of primary care physicians and other medical specialties for many years. ACEIs (angiotensin-converting enzyme inhibitors) are one of the families of medications with an antihypertensive effect with the greatest experience in their use over decades. A 70-year-old patient previously diagnosed with high blood pressure and treated with ACEI, began in January 2013 with progressive worsening of kidney function.There are several mechanisms by which ACEIs produce an AKF (Acute Kidney Failure), such as efferent arteriolar vasodilatation because of blocking Angiotensin 2 effect or inmunoallergic mechanisms, or even different pathologies that could trigger it (congestive heart failure, liver cirrhosis with ascites and in presence of bilateral renal stenosis or unilateral stenosis of a single functioning kidney). The use of ACEIs as a first-line treatment for high blood pressure is supported by diverse clinical guidelines and by excellent results in a broad profile of patients. In a small percentage of cases, they have shown adverse effects that can affect the functioning of several systems involved in the correct control of the patient's cardiovascular risk, such as the renal system.