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Adverse Effects of ACE Inhibitors
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
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Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
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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].
Thomas B. Edwards
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
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