[Iatrogenic angioedema: the role of angiotensin converting enzyme inhibitor and angiotensin II receptor blockers].
Nephrologists should be aware the fact that the angioedema is a common side effect not only under angiotensin-converting enzyme (ACE) inhibitors treatment but also under sartans therapy. The frequency of angioedema under ACE inhibitors is estimated at 1 to 7 per thousand. The physiopathology of ACE angioedema implicates the lack of degradation of kinines due to the inhibition of multiple enzymes activity including ACE. Angioedema under sartans seems less frequent than this observed under ACE inhibitors. Its mechanism remains poorly defined, but implicates the increase of kinine production via the stimulation of angiotensin receptor type II, and/or the lack of degradation of kinines via multiple enzymes other than ACE. The frequency of the apparition of angioedema under sartans in patients who had have angioedema under ACE inhibitors is inconsistent and varied from 7.7% to 50%. Reports indicated that angioedema under ACE or sartans could have a spontaneous regression. However, the relapse of angioedema under these drugs should lead to the diagnosis of iatrogenic etiology, and to the drugs withdrawal. ACE inhibitors/Sartans-associated angioedema episodes need to be reported to the French Adverse Event Reporting System database to evaluate their frequency and to avoid severe consequences.
Roskiewicz
France
F
Centre régional de pharmacovigilance, centre hospitalier universitaire Sud, avenue René-Laennec, 80054 Amiens cedex 01, France.
Andriamanana
Irina
I
Gras-Champel
Valérie
V
Andrejak
Michel
M
Massy
Ziad A
ZA
D000799:Angioedema / Q000139:chemically induced* / Q000517:prevention & control*; D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D000959:Antihypertensive Agents / Q000009:adverse effects*; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology* / Q000517:prevention & control*
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents