LETTER
Adverse Effects of ACE Inhibitors
Thomas B. Edwards
15 February 1993 | Volume 118 Issue 4 | Pages 314-315
TO THE EDITOR:
Your readers may be misled by the statement, "The onset usually occurs within hours or, at most, 1 week after starting therapy," in Israili and Hall's excellent review [1] of the adverse effects of angiotensin-converting enzyme (ACE) inhibitors. The authors correctly cite a case report of angioedema developing after long-term ACE inhibitor use [2] but fail to point out that at least 11 additional patients with often life-threatening angioedema occurring after 10 days to 1 year of ACE inhibitor therapy have also been reported [3, 4].
In the past month, I have evaluated two similar patients. One, a 65-year-old white man, was hospitalized for treatment of dyspnea and oropharyngeal angioedema. He had been taking enalapril for hypertension for 6 months. The second was a 42-year-old black woman who developed severe angioedema of the upper lip 4 months after starting lisinopril for hypertension. In both, other causes for angioedema were excluded.
Thus, the discontinuation of ACE inhibitor therapy should be seriously considered for patients developing angioedema, regardless of treatment duration [5].
1. Israili ZH, Hall WD. Cough and angioneurotic edema associated with angiotensin-converting enzyme inhibitor therapy. Ann Intern Med. 1992; 117:234-42.
2. Chin HL, Buchan DA. Severe angioedema after long-term use of an angiotensin-converting enzyme inhibitor (Letter). Ann Intern Med. 1990; 112:312-3.
3. Barna JS, Frable MS. Life-threatening angioedema. Otolaryngol Head Neck Surg. 1990; 103:795-8.
4. Gannon TH, Eby TL. Angioedema from angiotensin-converting enzyme inhibitors: a cause of upper airway obstruction. Laryngoscope. 1990; 100:1156-60.
5. Orfan N, Patterson R, Dykewicz MS. Severe angioedema related to ACE inhibitors in patients with a history of idiopathic angioedema. JAMA. 1990; 264:1287-9.
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