What is a life-threatening adverse effect of ACE inhibitors like lisinopril and what population is at higher risk?

• A. Angioedema; higher risk in African descent and with NSAID use.
• B. Severe hypotension in all patients.
• C. Hyperkalemia in most patients.
• D. Kidney failure in most patients.

Answer: (A)

ACE inhibitors can cause angioedema due to buildup of bradykinin when the enzyme that breaks it down is blocked. This swelling can involve the face, tongue, and especially the larynx, and if the airway is compromised it can become a life-threatening emergency. The risk is notably higher in people of African descent and when NSAIDs are used, which can amplify or worsen the edema. Because of this, stopping the ACE inhibitor and securing the airway are crucial steps if angioedema develops, with supportive care and, in severe cases, targeted therapy to block bradykinin effects. Other adverse effects like severe hypotension, hyperkalemia, or kidney issues can occur with ACE inhibitors, but they are not typically life-threatening in the same way as airway angioedema.