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

Abstract

Introduction

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.

Case description

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.

Discussion and conclusions

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.

Keywords:

• ACE inhibitors
• angioedema
• bradykinin

Transparency

Declaration of funding

This study was not funded.

Declaration of financial/other relationships

No potential conflict of interest was reported by the authors. CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

G.B., E.A.D. and L.M. designed this article. F.R. collected data. G.B., F.R., A.N.S., M.C.D., E.A.D. and L.M. did the analysis. G.B., A.N.S. and L.M. wrote the draft of the manuscript. F.R., E.A.D. and M.C.D. reviewed and gave critical comments on the manuscript draft. All authors reviewed, wrote and approved the final version. The corresponding author G.B. had ultimate responsibility for the decision to submit for publication.

Acknowledgements

The authors wish to acknowledgement the patient who also gave consent for the clinical information relating to this case to be reported in a medical publication.

English language editing and review services supplied by Victoria Grace.