Which statement about ACE inhibitors is NOT accurate?

• A. Cough can occur due to bradykinin accumulation; monitor for hyperkalemia due to reduced aldosterone.
• B. Hyperkalemia and cough are not associated with ACE inhibitors.
• C. ACE inhibitors can cause angioedema.
• D. They increase serum calcium levels in most patients.

Answer: (D)

ACE inhibitors work by blocking the enzyme that converts angiotensin I to angiotensin II, which also leads to increased bradykinin. This bradykinin buildup explains two common effects: a persistent dry cough and the risk of angioedema. They also lower aldosterone, which reduces potassium excretion in the kidneys, so hyperkalemia is another important consideration, especially in patients with kidney problems or those taking potassium-sparing meds.

Calcium levels, on the other hand, are not driven up by ACE inhibition. These drugs do not increase serum calcium in most patients; calcium homeostasis is not a direct effect of blocking ACE. That’s why the statement about increasing serum calcium is not accurate.