The most significant adverse effect of ACE inhibition is:

Ans. is 'a' i.e. Hypotension [Ref: KDT 5th/e, p 449 _First dose hypotension is a significant adverse effect of ACE inhibitorA steep fall in blood pressure may occur following the first dose of an ACE inhibitor particularly in patients with elevated peripheral resistance.Care should be exercised in patients who are salt depletedbeing treated with multiple antihypertensive drugs having congestive heart failure on diureticsIn the above mentioned situations, t/t should be initiated with very small doses of ACE inhibitors or salt intake should be increased and diuretics should be withdrawn before beginning the therapy.Other adverse effects of ACE inhibitorsHyperkalemiaIs an important risk factor in patients withimpaired renal functionon K+ sparing diureticsCoughPersistent brassy coughCaused by inhibition of bradykininRashes, urticaria Angioedema DysgeusiaReversible loss of taste sensationMore common with captoprilFetopathicTeratogenic when given in 2nd trimesterSafe in first half.Granulocytopenia and proteinuria Acute renal failureIt is precipitated by ACE inhibitors in patients with bilateral renal artery stenosis due to dilatation of efferent arterioles and fall in glomerular filtration pressure.