Interaction between ACE inhibitors and beta blockers

General information about ACE inhibitors

ACE inhibitors are drugs from the group of antihypertensive drugs.

They are used for high blood pressure, chronic heart failure and for prophylaxis in the case of strokes and heart attacks.

They develop their effect by inhibiting certain enzymes that produce angiotensin II from angiotensin I.
This enzyme will Angiotensin Converting Enzyme called, from which the name ACE inhibitor is derived.

The ACE enzyme is responsible in the body for causing blood vessels to constrict.
If this mechanism is switched off by an ACE inhibitor, vasodilation occurs (Dilation). This dilation leads to a decrease in blood vessel tone and thus to a decrease in blood pressure.

In addition to the antihypertensive effect through dilation of the vessels, ACE leads to a reduction in the release of aldosterone (please refer: Mineral corticoids) from the adrenal cortex.
Aldosterone is a steroid hormone which leads to an increased reabsorption of water and sodium in the kidneys.

Reabsorption of water leads to an increase in the volume of blood in the blood vessels, which increases blood pressure. This mechanism is switched off by the administration of ACE inhibitors and the blood pressure drops.

Another important function of ACE is the inactivation of bradykinin-degrading kinases (a type of enzyme). Bradykinin is a vasodilator tissue hormone.
By inhibiting the kinase mentioned, there remains Bradykinin longer available.

Also read: Bradykinin

The main active ingredients in ACE inhibitors are captopril, enalapril, lisinopril and ramipril.

Side effects of ACE inhibitors

Side effects that all ACE inhibitors can cause are:

• Hypotension, caused by too much reduction in blood pressure
• Hyperkalemia due to increased sodium excretion and
• Acute kidney failure.

Particular caution is required when taking it during pregnancy.

Read more on the topic: Lowering blood pressure during pregnancy

A side effect that occurs when taking ACE inhibitors is the so-called ACE inhibitor cough.
This is a dry cough that affects 5-35% of patients.

Asthma attacks and shortness of breath can also occur. This side effect arises from the inhibition of the bradykinin-degrading kinases, which leads to an overactivation of the bradykinins.
Bradykinin, which causes the bronchi to contract, can lead to bronchospasm and trigger a dry cough.

For more information, see: Bradykinin or cough

The attack of ACE inhibitors on the kidney function in the form of water retention can lead to acute kidney failure.
This side effect is mainly observed in patients with kidney failure.

Hyperkalemia occurs in less than 10% of patients. It occurs mainly in patients with renal insufficiency. It is also a risk factor for patients who are taking potassium-sparing diuretics or NSAIDs or who suffer from heart failure.

In general, caution should be exercised when taking ACE inhibitors in patients with kidney or heart failure.

Read more on the topic: Side effects of ACE inhibitors

Beta blockers: general and mechanism of action

Beta blockers are the drugs used by the Lowering blood pressure serve.

You block b-adrenoreceptors which for the release of the Stress hormone Adrenaline and the neurotransmitter Norepinephrine are responsible.

Adrenaline affects you Adrenergic receptors of the body.
Through its mediation, the Vascular tone (degree of opening of the vessels) increased, which leads to an increase in heart rate and blood pressure.

If this mechanism is switched off by beta blockers, it comes to Decrease in heart rate and des Blood pressure. Beta blockers are among the in Germany mostly prescribed drugs.

One of the active ingredients of the beta blockers is that Metoprolol. Metoprolol mainly attacks b1 receptors.

Side effects of beta blockers

Particular caution is required when taking beta-blockers in the presence of bronchial asthma or bradycardias (low heart rate).
Bradycardia is assumed if the heartbeat is less than 60 per minute.

Another contraindication of beta blockers is heart failure or existing conduction disorders of the heart.

Beta blockers are generally very well tolerated and can also be taken over a longer period of time.
However, treatment should always be carried out under medical supervision.

Basic side effects that can occur are

• Bradycardia (slow heartbeat),
• Heart failure, asthma attacks,
• Conduction disorders of the heart
• but also tiredness, depressed mood and erectile dysfunction.

In rare cases, arrhythmias and circulatory disorders of the peripheral (distant heart) vessels can occur.

Side effects can also be felt in the skin area.
This may include rashes, itching or reddening of the skin.

In the area of ​​the gastrointestinal tract, nausea, vomiting, as well as diarrhea and constipation can occur.

If you experience any side effects, you should always seek advice from a doctor and, under certain circumstances, stop taking beta-blockers.

Interactions when taking ACE inhibitors and beta blockers at the same time

The most common interactions of the two drugs are based on hers joint effect as a blood pressure lowering drug.

The effect of the beta blocker and the ACE inhibitor can reinforced by taking in parallel become.

This can lead to a increased drop in blood pressure lead and such a thing Bradycardia trigger (low heart rate).
Bradycadia can be very different symptoms cause.
These can be from Freedom from complaints up to faint or even one complete Be cardiac arrest.
The rapid drop in blood pressure can lead to the development of a Heart failure to lead.
In addition to bradycardia, you can also Cardiac arrhythmias occur which in the worst case lead to heart failure.

It should be noted that the Interaction depending on ingestion, for example in tablet form or by syringe, differently can fail.

When taking oral antidiabetic drugs (diabetes mellitus medication), care must be taken that both ACE inhibitors and beta blockers Increase the effect of these drugs.

This can be compounded Hypoglycemia (Hypoglycaemia).
Hypoglycemia shows up as a tachycardia (rapid heartbeat) and a Tremble (tremor).

Taking beta blockers and / or ACE inhibitors is one regular blood sugar control required by the doctor.

The parallel intake so of beta blockers and ACE inhibitors should always discussed with the doctor be to a mutual reinforcement lowering blood pressure to exclude.

If comedication of the two drugs cannot be prevented, this should always be avoided monitoring of the Heart rate and des Blood pressure done by their doctor.
If interactions occur, the dosage both drugs customized or discontinue any of the medications.