E. Adverse Effects
Below is a list of adverse affects of ACE inhibitors.
1. Hypotension may occur if the dose of ACE inhibitor is excessive, particularly if a diuretic is used before the addition off the ACE inhibitor. Lightheadedness, dizziness, and a faint feeling may occur. The initial dose should be small in elderly patients and in patients with heart failure.
2. Kidney failure may become worse if hypotension occurs or if the patient has severe obstruction in one renal artery or tight renal artery stenosis. Fortunately, renal artery stenosis is uncommon.
3. Hyperkalemia may occur if kidney failure is progres¬sive or if a potassium-sparing diuretic, potassium supplements, or salt substitutes are added to the treatment regimen.
4. Cough occurs in up to 20% of patients; it is sufficiently bothersome to promote the discontinua¬tion of medications in about 10% of treated patients. Cough occurs because of the accumulation of bradykinin.
5. Loss of taste has been reported in up to 7% of patients.
6. Extensive skin rash with severe itching may occur in greater than 10% of patients.
7. Angioedema is a life-threatening complication that occurs in approximately 0.8% of patients. Bradykinin and kallidin mediate hereditary angioedema. ACE inhibition results in the accumulation of bradykinin which can cause angioedema. Swelling of the eyelids, lips, and tongue may occur. Most important, swelling of the upper airway may obstruct air entry to the lung and death can occur if treatment is not immediately available.

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