CCB, RAS meds and peripheral edema

Q: Adding an angiotensin-converting enzyme (ACE) inhibitor may worsen the peripheral edemа due to calcium channel blockers (CCB).

A) True

B) False

Answer: B

CCB are well known to cause peripheral edemа. This edema does not respond to diuretics as this is not due to increased plasma volume but due to the redistribution of fluid from vascular space into the interstitium.

Adding an ACE inhibitor, an angiotensin receptor blocker (ARB), or a direct renin inhibitor significantly reduces both the incidence and severity of еdemа secondary to CCB. The Mechanism of action is  ACE inhibitor or ARB-mediated venodilation, which reduces the transcapillary pressure.

#cardiology

#pharmacology

References:

1. Makani H, Bangalore S, Romero J, et al. Peripheral edema associated with calcium channel blockers: incidence and withdrawal rate--a meta-analysis of randomized trials. J Hypertens 2011; 29:1270.

2. Savage RD, Visentin JD, Bronskill SE, et al. Evaluation of a Common Prescribing Cascade of Calcium Channel Blockers and Diuretics in Older Adults With Hypertension. JAMA Intern Med 2020; 180:643.

3. Makani H, Bangalore S, Romero J, et al. Effect of renin-angiotensin system blockade on calcium channel blocker-associated peripheral edema. Am J Med 2011; 124:128.