Angiotensin-converting enzyme inhibitor induced angioedema: not always a class effect? A case report and short narrative review

Bradykinin-mediated angioedema is a rare but potentially fatal adverse event. Angioedema induced by angiotensin-converting enzyme (ACE) inhibitors is generally attributed to an inhibition of bradykinin degradation following ACE inhibition. Clinical studies on ACE inhibitors mainly focus on their eff...

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Bibliographic Details
Published in:Current medical research and opinion 2021-11, Vol.37 (11), p.1855-1858
Main Authors: Becker, Guillaume, Rougerie, Fabien, Sabo, Amelia-Naomi, Dalmas, Marie-Caroline, Ayme-Dietrich, Estelle, Monassier, Laurent
Format: Article
Language:English
Subjects:
Angioedema - chemically induced
Angiotensin-Converting Enzyme Inhibitors - adverse effects
Bradykinin
Human health and pathology
Humans
Life Sciences
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Summary:Bradykinin-mediated angioedema is a rare but potentially fatal adverse event. Angioedema induced by angiotensin-converting enzyme (ACE) inhibitors is generally attributed to an inhibition of bradykinin degradation following ACE inhibition. Clinical studies on ACE inhibitors mainly focus on their efficacy. Few examine their potential to generate undesirable adverse effects, particularly with regard to angioedema. We report here a case of angioedema occurring after ramipril initiation in a patient chronically treated with quinapril. Angioedema subsided spontaneously after ramipril discontinuation and quinapril reintroduction. Our clinical case suggests that despite similar pharmacodynamic properties, quinapril and ramipril do not have the same potential to generate angioedema. To explain this difference, we suggest a potentiation of the effect of bradykinin at the B2 receptor level by ramipril, which does not occur with quinapril. Consequently, angioedema may not always be a class effect of ACE inhibitors.
ISSN:0300-7995
1473-4877
DOI:10.1080/03007995.2021.1971183