Brown NJ, Ray WA, Griffin MR
Increased incidence of angioedema in blacks treated with
ace-inhibitors
11th Scientific Meeting, American Society of Hypertension
Am J Hypert
(Apr) 9:193A 1996
Angioedema is an uncommon, but sometimes serious, and rarely fatal
complication of ACE inhibitors.
It may be worse with long-acting compounds. The incidence is about 1-4/1000,
but this is in
Caucasian populations. The mechanism is purported to be via the kinin
system, although there is one
recent report of
angioedema due to losartan , which does not affect kinin metabolism.
Brown et al used the Tennessee Medicaid database to examine the incidence of
angioedema, and found
it to be 2 per 1000 vs. 0.8 per 1000 for calcium channel blockers (a
relatively high figure, it
seems, for the latter). When they examined the data by race, however, they
found that the relative
risk for African Americans was 3.5! The rate was higher with lisinopril or
enalapril than with
captopril.
Comment: The study is interesting. No mechanism is proposed, although
African American
patients have been shown to have apparently heritable dysregulation of
kallikrein responses (see
relevant hyperlinks below).
(John T. Daugirdas, M.D., University of Illinois at Chicago)
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11th Scientific Meeting, American Society of Hypertension
H: Special problems :
Ethnic populations
H: Drug therapy :
ACE inhibitors