ACE Inhibitors In Cardiovascular Disease: China 2025 Consensus
The 2025 Chinese consensus reaffirms ACE inhibitors as cornerstone therapy for hypertension, heart failure, and kidney disease, with clear cautions on safety.
What ACE Inhibitors Do
ACE inhibitors block the renin-angiotensin system and lower angiotensin II. This relaxes blood vessels and reduces strain on the heart and kidneys.
They also raise bradykinin, which helps blood vessels and the endothelium. These effects give broad cardiovascular and renal protection.
Main Uses
They are first-line for hypertension, heart failure with reduced ejection fraction, chronic kidney disease, and diabetes. They also help after heart attack and with atrial fibrillation.
Guidelines recommend them alone or with a calcium-channel blocker or thiazide diuretic. They work well in salt-sensitive and sleep-apnea related hypertension.
In Heart Failure
For systolic heart failure, start at a low dose and increase slowly to the highest tolerated dose. Blood pressure, potassium, and kidney function are checked during changes.
Long-term use reduces hospitalization and death. Sudden stopping should be avoided once the patient is stable.
Safety And Side Effects
A dry cough is the most common nuisance effect and may lead to switching to an ARB. Rare but serious angioedema needs urgent medical attention.
High potassium can occur, so blood tests are important. They are not used with bilateral renal artery narrowing or during pregnancy.
