Quinapril

How it works

Its active metabolite quinaprilat inhibits ACE, reducing angiotensin II formation and aldosterone secretion, which lowers vasoconstriction and blood pressure.

Prescribing in practice

• Contraindicated in pregnancy and in patients with a history of ACE inhibitor-associated angioedema.
• Risk of significant hyperkalaemia and renal impairment, especially with concomitant potassium-sparing diuretics, potassium supplements, NSAIDs or in renal artery stenosis.
• Initiate with care in volume-depleted patients owing to the risk of first-dose hypotension.

Monitoring

Check renal function and serum potassium before starting and after initiation or dose changes, alongside blood pressure.

Counselling the patient

• Report any swelling of the face, lips, tongue or throat urgently.
• A dry persistent cough can occur; mention it to your clinician.
• Avoid potassium-containing salt substitutes and tell your clinician if you may be pregnant.

Evidence & guidelines

ACE inhibitors improve outcomes in hypertension and heart failure and are recommended first-line options in relevant NICE guidance.