Captopril, enalapril, lisinopril, ramipril , perindopril, trandolapril, fosinopril and moexipril etc are the compounds in this group.

Important differences between  captopril and other ACEIs is that captopril is less potent , has fast onset and short duration of action and less absorption in presence of food in GIT . Because of short and fast action, it can cause postural hypotension which is not seen with other ACEI.

Perindopril is longest acting whereas captopril is shortest acting ACE inhibitor. All ACEI are prodrugs except captopril and lisinopril. Other drugs like enalapril are converted to its active metabolite (enalaprilat) and thus are slow acting. Enalaprilat is available as a seperate drug meant for use in hypetensive emergencies by iv route.

* ACEI are used for the treatment of of hypertension,CHF, evolving ,MI, diabetic retinopathy , non diabetic renal disease and also in scleroderma crisis .These drugs reduce protienuria in diabetic as well as non- diabetic renal disease and also prevent the manifesations of scleroderma crisis which are mediated by angiotensin II.

The most frequent adverse effect associated with these agents is dry cough. It can be reduced by iron supplements and aspirin. ACEI can also cause angioedema. Both cough and angioedema is due to elevated levels of bradykinin.

Q. ACE inhibitors are contraindicated in

A) Diabetes mellitus
B) Hypertension in old age groups
C) Scleroderma
D) Bilateral renal artery stenosis

Ans : D