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ACL lnhlblLors

ACL lnhlblLors are used malnly ln Lhe LreaLmenL of hyperLenslon (hlgh blood pressure) and hearL
fallure 1hey are also used ln some people wlLh dlabeLes for some forms of kldney dlsease and afLer
a hearL aLLack Lo help Lo proLecL Lhe hearL 1hey have a varleLy of effecLs on Lhe body 1helr ablllLy Lo
relax blood vessels ls one of Lhe mosL lmporLanL 1he slde effecLs mosL commonly assoclaLed wlLh
ACL lnhlblLors are mlnor 1he mosL common slde effecL ls a perslsLenL dry cough
WhaL are ACL lnhlblLors?

ACL lnhlblLors are a class (group) of drugs LhaL are used ln Lhe LreaLmenL of varlous dlsorders 1helr
correcL name ls AngloLensln ConverLlng Lnzyme lnhlblLors whlch ls usually shorLened Lo ACL
lnhlblLors 1hey lnclude capLoprll cllazaprll enalaprll foslnoprll lmldaprll llslnoprll moexlprll
perlndoprll qulnaprll ramlprll and Lrandolaprll Lach of Lhese drugs also has varlous dlfferenL brand
names Some ACL lnhlblLor drugs are also parL of a comblned LableL wlLh a calclum channel blockers
or dlureLlc (waLer LableL)
WhaL condlLlons are ACL lnhlblLors used Lo LreaL?

ACL lnhlblLors are used Lo LreaL a number of dlfferenL condlLlons
PyperLenslon ACL lnhlblLors are usually effecLlve aL lowerlng blood pressure
PearL fallure ACL lnhlblLors reduce Lhe sLraln on Lhe hearL by decreaslng Lhe amounL of fluld
pumped around Lhe body 1hey also help Lhe hearL by relaxlng blood vessels 1hls reduces Lhe
amounL of force needed Lo e[ecL blood from Lhe hearL
ulabeLlc nephropaLhy (dlabeLlc kldney dlsease) Lhese drugs can help Lo malnLaln good kldney
funcLlon
Chronlc kldney dlsease ACL lnhlblLors may help Lo slow Lhe progress of kldney dlsease
AfLer a myocardlal lnfarcLlon (hearL aLLack)
Pow do ACL lnhlblLors work?

ACL lnhlblLors prevenL Lhe body from creaLlng a hormone known as angloLensln ll 1hey do Lhls by
blocklng (lnhlblLlng) a speclal chemlcal called angloLensln converLlng enzyme 1hls has a varleLy of
effecLs buL essenLlally relaxes blood vessels and helps Lo reduce Lhe amounL of waLer reabsorbed by
Lhe kldneys 1hese acLlons help Lo decrease blood pressure as explalned below

our body has a number of dlfferenL ways of malnLalnlng your blood pressure buL Lhere are Lwo
maln elemenLs Cne of Lhe ma[or facLors ls Lhe reslsLance of Lhe body's blood vessels lf Lhe blood
vessels consLrlcL (LlghLen) reslsLance lncreases lf Lhe blood vessels dllaLe (relax) Lhe reslsLance ls
lower lf you have Lhe same amounL of fluld Lravelllng ln one vessel Lhe pressure wlll be hlgher when
Lhe vessel ls consLrlcLed Lhan when lL ls relaxed

1he oLher ma[or facLor lnfluenclng blood pressure ls how much blood ls pumped ouL of Lhe hearL ln
a healLhy person Lhls depends on your hearL raLe (pulse) and Lhe amounL of blood LhaL enLers and
leaves Lhe hearL's chambers 1hls ls known as cardlac (hearL) ouLpuL

our blood pressure ls Lhe resulL of comblnlng Lhese Lwo facLors lL wlll be hlgh lf your vessels are
consLrlcLed and Lhere ls loLs of blood clrculaLlng Lhrough Lhe hearL lL wlll be lower lf your vessels are
dllaLed and Lhere ls less blood clrculaLlng Lhrough Lhe hearL ACL lnhlblLors work by LargeLlng boLh of
Lhese sysLems

8lood ls noL [usL made up of red blood cells buL also conLalns a large amounL of fluld called plasma
our kldneys conLrol how much fluld you keep ln your blood and how much you lose as urlne 8y re
absorblng (reLalnlng) waLer LhaL would oLherwlse become urlne Lhe kldneys lncrease Lhe amounL of
fluld ln Lhe blood 1hls lncreases blood volume

ln good healLh you have an lnLrlcaLe sysLem seL up Lo malnLaln your blood pressure When your
kldneys sense LhaL your blood pressure has dropped a subsLance called renln ls released lnLo Lhe
bloodsLream 8enln works on anoLher chemlcal Lo form angloLensln l 1hen Lhe angloLensln
converLlng enzyme (ACL) changes angloLensln l Lo angloLensln ll

AngloLensln ll ls Lhe acLlve hormone lL has Lhree maln effecLs
ConsLrlcLlon of blood vessels
8eabsorpLlon of waLer by Lhe kldneys
8elease of Lhe hormone aldosLerone whlch also causes waLer reabsorpLlon by Lhe kldneys
lncreaslng Lhe volume of Lhe blood by addlng more waLer and consLrlcLlng your blood vessels
lncreases blood pressure

ACL lnhlblLors sLop angloLensln l from becomlng angloLensln ll 1hls reduces Lhe amounL of
angloLensln ll whlch causes blood vessels Lo dllaLe 1he amounL of waLer puL back lnLo Lhe blood by
Lhe kldneys decreases 1hese acLlons reduce blood pressure

ln hyperLenslon ACL lnhlblLors should help Lo reduce Lhe blood pressure
ln hearL fallure Lhere may be Loo much clrculaLlng fluld ln Lhe blood vessels ACL lnhlblLors help Lo
reduce Lhls 1hey also appear Lo have some form of proLecLlve effecL on Lhe hearL and may slow Lhe
progresslon of Lhe hearL fallure
urugs ln Lhe class of drugs called angloLensln ll recepLor anLagonlsLs work ln a slmllar way Lo ACL
lnhlblLors Cne may be used lnsLead of an ACL lnhlblLor lf you have problems or sldeeffecLs wlLh
Laklng an ACL lnhlblLor (such as a perslsLenL cough)
Whlch ls Lhe besL ACL lnhlblLor?

Cllnlcal Lrlals suggesL ACL lnhlblLors are all abouL equally effecLlve aL LreaLlng hyperLenslon and hearL
fallure
nPS guldellnes suggesL enalaprll llslnoprll perlndoprll ramlprll or Lrandolaprll for people wlLh
hyperLenslon 1here ls good medlcal evldence LhaL Lhese ACL lnhlblLors reduce your longLerm
llkellhood of sufferlng from a hearL aLLack or sLroke
nPS guldellnes recommend enalaprll llslnoprll and ramlprll for Lhe LreaLmenL of hearL fallure 1hese
drugs have Lhe mosL medlcal evldence Lo supporL Lhelr use and docLors generally have more
experlence uslng Lhem Powever oLher drugs are avallable for use ln hearL fallure and ln cerLaln cases
your docLor may prescrlbe an alLernaLlve
Can l buy ACL lnhlblLors or are Lhey [usL avallable on prescrlpLlon?

1hese drugs are prescrlpLlon only as Lhey requlre speclal monlLorlng of your kldneys
Pow do l Lake ACL lnhlblLors?

A blood LesL ls usually done before sLarLlng an ACL lnhlblLor and abouL 710 days afLer Lhe flrsL dose
ou may also requlre furLher blood LesLs as your dose lncreases 1hese LesLs check on Lhe funcLlon of
Lhe kldneys 1he kldneys are affecLed ln a small number of people who Lake an ACL lnhlblLor A blood
LesL every year ls Lhen usual

A very small number of people may be requlred Lo sLarL Lhelr LreaLmenL wlLh ACL lnhlblLors ln
hosplLal so LhaL careful monlLorlng can be underLaken

our docLor wlll advlse you how Lo Lake your medlcaLlon lncludlng how ofLen Cenerally you wlll be
sLarLed on a low dose Lo make sure you are coplng well and LhaL your blood pressure responds ln an
approprlaLe way

ln some people Lhe flrsL dose can cause a drop ln blood pressure lmmedlaLely 1he followlng ls advlce
for sLarLlng ACL lnhlblLors
lf you Lake a dlureLlc (waLer LableL) you may be advlsed noL Lo Lake lL for a day or so before sLarLlng
an ACL lnhlblLor
AfLer Lhe very flrsL dose on Lhe flrsL day you sLarL an ACL lnhlblLor
SLay lndoors for abouL four hours as occaslonally some people feel dlzzy
lf you do feel dlzzy slL or lle down and lL wlll usually ease off
lf you become very dlzzy conLacL your docLor lmmedlaLely
1hereafLer Lhere ls no need Lo Lake any speclal precauLlons
Pow qulckly do ACL lnhlblLors work?

1hese drugs can work very qulckly ln hyperLenslon lf you have hearL fallure lL may be weeks or
monLhs before you noLlce an lmprovemenL ln your sympLoms
Pow long ls LreaLmenL needed?

Cnce you have sLarLed Laklng an ACL lnhlblLor you wlll generally keep Laklng lL lndeflnlLely unless
you experlence an adverse effecL
Who cannoL Lake ACL lnhlblLors?

A full llsL of people who should noL Lake ACL lnhlblLors ls lncluded wlLh Lhe lnformaLlon leafleL LhaL
comes ln Lhe drug packeL lf you are prescrlbed ACL lnhlblLors read Lhls Lo be sure you are safe Lo
Lake lL

lor example people who should noL Lake ACL lnhlblLors lnclude
regnanL and breasLfeedlng women
1hose wlLh a known senslLlvlLy Lo ACL lnhlblLors
1hose wlLh forms of anglooedema (swelllng of Lhe llps eyes or Longue)
eople wlLh cerLaln Lypes of kldney dlsease for example renal arLery sLenosls
WhaL abouL sldeeffecLs?

1he mosL common slde effecL assoclaLed wlLh an ACL lnhlblLor ls hypoLenslon (low blood pressure)
ou may have no sympLoms of Lhls or lL may make you feel dlzzy lf you experlence Lhls you should
reporL lL Lo your docLor Around one ln Len people who Lake an ACL lnhlblLor have a perslsLenL dry
cough Less common slde effecLs lnclude anglooedema (swelllng of Lhe llps eyes or Longue) and a
decllne ln kldney funcLlon

A number of drugs may lnLeracL wlLh ACL lnhlblLors ln parLlcular nonsLeroldal anLllnflammaLory
drugs (nSAlus) dlureLlcs (waLer LableLs) and llLhlum our docLor wlll normally check whaL oLher
drugs you Lake and glve furLher advlce abouL Lhls

lor a full llsL of all Lhe slde effecLs and posslble lnLeracLlons assoclaLed wlLh your drug consulL Lhe
leafleL LhaL comes wlLh your medlcaLlon