Managing High Blood Pressure
Evidence suggests that best drugs for patients with high blood pressure and PAD may be angiotensin-converting-enzyme (ACE) inhibitors. These drugs block the effects of the angiotensin-renin-aldosterone system, which is thought to have many harmful effects on the heart and blood vessels.
ACE inhibitors include:
- Captopril (Capoten)
- Enalapril (Vasotec)
- Quinapril (Accupril)
- Benazepril (Lotensin)
- Ramipril (Altace)
- Perindopril (Aceon)
- Lisinopril (Prinivil, Zestril)
They are important drugs for patients with peripheral artery disease and those with diabetes who also have high blood pressure.
Side effects include an irritating cough, excessive drop in blood pressure, and allergic reactions. In some people, the cough is intolerable. Iron supplements or the drug picotamide may help reduce the frequency of coughs.
One rare, but severe, side effect is granulocytopenia, which is an extreme reduction in white blood cells.
In rare cases (0.3%), patients who take ACE inhibitors suffer a sudden and severe allergic reaction called angioedema, which causes swelling in the eyes and mouth and may close off the throat.
Although ACE inhibitors can protect against kidney disease, they also increase potassium retention in the kidneys. This increases the risk for cardiac arrest if levels become too high. Because of this, ACE inhibitors are generally not given with potassium-sparing diuretics or potassium supplements.
ACE inhibitors can harm a developing fetus and should not be used during pregnancy, particularly in the second and third trimester.
[For more information on blood pressure drugs, see In-Depth Report #14: High blood pressure.]
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