ACE inhibitors are a category of medications such as enalapril and lisinopril which are typically used to treat high blood pressure. Around 40 million people in America rely on these medications and ACE inhibitors account for one-third of all blood pressure medication prescriptions. While these medications have helped millions of individuals worldwide, they are not without any side effects or risks associated with their use. There is a rare condition linked to the use of ACE inhibitors that affects less than 1% of all its users, called angioedema. This condition is characterized by swelling that is often attributed to other factors. However, this condition can be life-threatening, therefore, it is important to recognize its signs.
What Is Angioedema?
People with this condition experience swelling of the deep tissues located in the mouth, throat, face, and neck. In addition to the use of ACE inhibitors, angioedema can be caused by a number of conditions, such as infections and allergic reactions. In medical terms, this is referred to as “ACE inhibitor-induced angioedema”. While the side effects of this condition may look similar to one, it is not a true allergy. One side effect of ACE inhibitor use is that it increases levels of bradykinin. This protein plays a part in the inflammatory processes of the body and can trigger swelling. Your body naturally breaks down this protein most of the time.
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Who Is Most At Risk?
Certain individuals’ bodies are not as efficient at breaking this protein down, putting them at greater risk of developing angioedema. While anyone can develop ACE inhibitor-induced angioedema, certain individuals have a higher risk. This increased risk is due to both acquired and genetic factors. African Americans are particularly at risk and are considered seven times more likely to develop this condition. People most at risk are those who previously had angioedema episodes, were female, were 65 years of age or older, and smoked.
The Symptoms of Angioedema
Angioedema symptoms can differ from one individual to another. It typically starts with a notable swelling of the face, lips, and tongue. This swelling is typically asymmetric, with it usually starting on one side of the mouth or face. No finger impressions are left behind when pressing down on the swollen area. Unlike typical allergic reactions, there is no accompanying rash or itching. On some occasions, the swelling can severely affect your airway, resulting in hoarseness, difficulty breathing, and blocked airways. In less common cases, angioedema can also affect the gastrointestinal tract lining. This swelling in the gut can lead to vomiting, abdominal pain, ascites, and a lack of appetite.
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How Is Angioedema Diagnosed?
There is no specific angioedema test that can determine if you have the condition or not. Rather, your GP will determine whether you have angioedema or not by examining your symptoms. If your GP feels that there may be another source of the swelling other than the ACE inhibitor use, they may order more lab tests to be carried out. GI tract angioedema can often be more challenging to diagnose. If you are experiencing symptoms such as abdominal pain and vomiting, imaging may be helpful. Your GP might suggest that they take a CT scan or ultrasound of your abdominal area.
Angioedema Treatment
Treatment of this condition typically requires that all ACE inhibitor use is ceased. If people continue using the medication, the swelling can become more regular and more severe. Even after stopping, some people still experience swelling episodes for several months afterward. Researchers have also tried treating the condition using several different methods, however, their efficacy has yet to be proven. These treatments include the use of bradykinin receptor antagonists and fresh frozen plasma. The use of frozen plasma is somewhat rare though, as it can exacerbate swelling before eventually getting any better.
The Bottom Line
While ACE inhibitors are widely used by many people, it is important to be aware of the symptoms associated with angioedema. If you experience any degree of swelling in your mouth, lips, tongue, or face, it is advised to see a medical professional. Mild symptoms may only require an appointment with your GP, however, if you experience difficulty breathing or continuous swelling, it may be better to head straight to an emergency room.
Disclaimer: This information is not intended to be a substitute for professional medical advice, diagnosis or treatment and is for information only. Always seek the advice of your physician or another qualified health provider with any questions about your medical condition and/or current medication. Do not disregard professional medical advice or delay seeking advice or treatment because of something you have read here.
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