Angioedema caused by cardiovascular medications

About 0.1-0.6% of patients treated with Angiotensin Converting Enzyme (ACE) inhibitors develop angioedema. Swelling attacks have also been reported, though less frequently, in patient taking angiotensin-II receptor subtype 1 antagonists (AT-1 blockers). ACE inhibitors and AT-1 blockers are medications commonly prescribed to patients with hypertension (high blood pressure) as well as those with cardiac insufficiency, following a heart attack or with renal insufficiency. Because of their similar mechanisms of action, ACE inhibitors and AT-1 blockers are grouped under the somewhat complex heading of Renin-Angiotensin-Aldosterone-System (RAAS) inhibitors.

If you do not know whether you have been prescribed an ACE inhibitor or AT-1 blocker, we recommend that you look at the package insert delivered with your medication. The medication’s generic or chemical name is given at the top.

  • ACE inhibitors have generic or chemical names that end in “-pril”, for example: Benazepril, Captopril, Cilazapril, Enalapril, Fosinopril, Lisinopril, Moexipril, Perindopril, Quinapril, Ramipril, Spirapril, Trandolapril.
  • AT-1 antagonists have generic or chemical names end in “-sartan”, for example: Candesartan, Losartan, Valsartan.

The swelling attacks associated with the use of ACE inhibitors or AT-1 blockers are also mediated by bradykinin. Because these drugs inhibit the natural breakdown of bradykinin, there may be an increase in circulating bradykinin levels, which, in turn, increases the permeability of the vascular wall, thus promoting the development of angioedema.

About half of affected patients develop angioedema within the first two months after starting the medication. Swelling attacks may, however, occur after months or even years of well-tolerated use of the medication.

Angioedema caused by use of these cardiovascular medications frequently occurs as swelling of tissues in the head and neck, especially of the face, lips, tongue and larynx. In this form of angioedema, the family history is negative, meaning that there are no other known cases of the illness in the family. Even after stopping the medication, complaints may persist for several weeks.