the Current Evidence Combined Treatment With Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers: A Review of Published by:

at PENNSYLVANIA STATE UNIV on March 6, 2014cpt.sagepub.comDownloaded from There is an increasing interest in pharmacologic treat-ment that interferes with the renin-angiotensin system (RAS). The first drugs used to block the RAS were angiotensin-converting enzyme (ACE) inhibitors, which inhibit the conversion of angiotensin I to angiotensin II. This drug category is safe and effec-tive; however, it has a range of adverse effects. ACE inhibitors block the kininase activity of ACE, result-ing in increased bradykinin levels (1). This can lead to dry cough, one of the most frequent adverse effects in patients treated with ACE inhibitors and also to some rare but potentially dangerous side effects, such as angioedema (1). On the other hand, bradykinin is an effective vasodilator that may contribute to the bene