Which adverse effects are associated with ACE inhibitors?

• A. ACEI cough, angioedema, acute kidney injury, hyperkalemia, hypotension
• B. Hypoglycemia
• C. QT prolongation
• D. Hypercalcemia

Answer: (A)

ACE inhibitors have a distinctive profile of adverse effects tied to how they influence vascular tone and bradykinin metabolism. The cough and angioedema come from increased bradykinin (and related mediators) that ACE normally helps break down; when ACE is blocked, bradykinin accumulates and can irritate the airways or promote swelling in the deeper layers of skin and mucosa.

Hyperkalemia and hypotension arise because blocking angiotensin II reduces aldosterone release and causes systemic vasodilation. Less aldosterone means reduced potassium excretion, raising potassium levels, while vasodilation lowers blood pressure. The effect on renal hemodynamics can also precipitate acute kidney injury, especially in settings of volume depletion or bilateral renal artery stenosis, where the efferent arteriole dilation from ACE inhibition reduces glomerular pressure.

These adverse effects are characteristic of ACE inhibitors, while other listed effects like hypoglycemia, QT prolongation, or hypercalcemia are not typical for this drug class.