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Your doctor may recommend a different medication. Doctors commonly prescribe ACE inhibitors because they don't often cause side effects. In rare cases, particularly for black people, women and smokers, ACE inhibitors can cause some areas of the tissues to swell angioedema.

If swelling occurs in the throat, it can be life-threatening. ACE inhibitors can be harmful to you and your baby during pregnancy. If you're pregnant or plan to become pregnant, talk to your doctor about other options to treat high blood pressure. Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Mayo Clinic is a nonprofit organization and proceeds from Web advertising help support our mission.

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ACE inhibitors: List, side effects, and more

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By Mayo Clinic Staff. Show references Mann JFE. Choice of drug therapy in primary essential hypertension. Accessed June 25, Types of blood pressure medications. American Heart Association. Sidawy AN, et al. Atherosclerotic risk factors: Hypertension.

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  • However, this difference in the effect of sublingual versus oral intake may equalize after 60 minutes Furthermore, the bitter taste of sublingual Captopril may bother patients 7 and cause a chemical burn in the oral mucosa as well as hypersensitivity 6. After the use of Nifedipine was condemned 6 , sublingual Captopril has been widely used to control severe hypertension in hypertensive urgencies.

    However, tolerance to sublingual administration is not as good as oral administration 7 , and it is unclear whether there are any additional benefits with sublingual administration.

    Pharmacologic treatment

    Therefore, this study was performed to evaluate the efficacy, possible side effects, and patient satisfaction of sublingual versus oral Captopril. In this randomized clinical trial, patients admitted to the emergency department of two hospitals in Shahroud, Iran, during the years of and , were included in the study.

    BP was measured at least twice in the sitting position with at least 5-minutes intervals. Among the included patients who were considered for the study, 17 were excluded as they were unwilling to participate in the study and three were excluded for other reasons Figure 1. Iran; 35 patients in each group. Heart rates HR were also measured by the investigator by counting the pulse rate.

    The patients were asked whether they were experiencing any discomfort, including headache, dizziness, nausea, vomiting, muscle cramps, abdominal pain, indigestion, dry mouth, cough, flushing, urticaria, skin rashes, or bitter taste. At the end of BP measurement, the patients were asked to score their satisfaction with the route of administration compared with their previous experience on a scale of 1 - Basic characteristics and all other data were recorded in a checklist.

    The primary outcome of the study was the decrease in SBP at 30 minutes. Besides treatment of hypertension by oral or sublingual Captopril, if BP was not under control after minutes, the emergency department physician decided about other possible treatments independently. The study was conducted as part of a thesis under the medical doctor program at the Islamic Azad University.

    The local Ethical committee at Islamic Azad University approved the study protocol, and the Ethical guidelines of the Declaration of Helsinki were considered.

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    • Captopril - an overview | ScienceDirect Topics;
    • Written signed consents were obtained after explaining the trial to the patients. The sample size was calculated based on a pilot study of 10 patients. Statistical analysis was performed using the statistical software SPSS version Categorical variables are represented as numbers and percentages. For comparison of changes in BP in the SR and OR groups, independent sample t-test if it showed a normal distribution or Mann-Whitney, non-parametric test if did not have normal distribution was considered.

      For evaluation of the changes in two related samples, paired t-test or non-parametric Wilcoxon Signed Ranks when needed was performed. The categorical variables were compared using the Pearson Chi-square or the Fisher exact test, as required.


      The basic characteristics of the two groups are presented in Table 1. A repeated measures analysis with a Greenhouse- Geisser correction determined that mean SBP differed statistically significantly between the time points considering the synchronous and interactive effect of the time and method of the Captopril usage. At baseline, the mean HR in the groups was Figure 3 shows the trend of changes in HR in the two groups.

      The mean HR showed a minimal increase from The mean scores for patient satisfaction were 7.

      The highest score in the SL group was 8. It is possible that sublingual Captopril may have a faster onset of action than that of oral Captopril 7 , 10 , 14 , 15 , 19 , 24 , 25 , which may be helpful in an emergency setting. Sublingual Nifedipine may have been replaced by sublingual Captopril, because of the slower onset of action 13 , 19 , 21 and similar efficacy 12 , 21 , On the other hand, the decrease in DBP was not statistically significant. Most 10 , 14 , 15 , 19 , 25 but not all 7 studies have shown a more rapid antihypertensive effect with the sublingual route than the oral route, which equalizes after 60 minutes Karakilic et al.

      Furthermore, we randomized our patients to prevent possible biases. Evaluating the clinical effect of medication, we did not measure the blood levels of the drug.

      Cardiac - Hypertension (HTN)

      Hence, sooner action of the sublingual prescription according to our finding was a clinical response and not confirmed by the laboratory. In many studies, a decrease 12 , 18 , 20 or no change in HR after sublingual Captopril intake was observed 13 the reason underlying increased fatal ischemic outcomes with Nifedipine intake 6.

      Captopril or Atenolol for Hypertension in Diabetes?

      Our study also did not show any significant increase in HR after sublingual or oral Captopril intake. Most of the studies performed on the use of Captopril in hypertension emergency have also not found any important side effects 11 , 13 , There have been only a few reports of headache, nausea, and vomiting 7.

      In our study, only two patients in the SL Captopril group complained of headache. However, whether headache is more prevalent with sublingual Captopril than with oral Captopril, remains to be investigated in further studies. None of the patients in the SL group were completely satisfied with the route of drug intake the maximum score was 8 , whereas more than half of the patients in the OR group were fully satisfied half had score of The bitter taste of sublingual Captopril may be the reason for their displeasure 7.

      Furthermore sublingual prescription can cause chemical burns in the oral mucosa as well as hypersensitivity 6. This novel finding in our study, in the absence of clear benefit of early onset of the action of the drug and equalization of the effect after 90 minutes, may have important clinical implications and could be considered by the physicians for the choice of route of Captopril administration.

      Our study showed that in hypertensive patients without acute target organ damage, sublingual Captopril can decrease SBP and MBP but not DBP more rapidly than oral captopril in the first 30 minutes after intake. The change in heart rate was minimal after sublingual and oral administration and a few side effects were observed.