Which of the following is an absolute contraindication to ACE inhibitors or ARBs?

• A. Asthma
• B. Hypertension
• C. Hyperlipidemia
• D. Angioedema

Answer: (D)

Angioedema is the key risk that makes ACE inhibitors and ARBs unsafe. Angioedema is rapid swelling of the deeper layers of skin and mucosa, often affecting the lips, tongue, or throat, and it can block the airway. ACE inhibitors increase bradykinin levels, which can trigger this swelling, sometimes severely. Because of the potential for life-threatening airway compromise, a history of angioedema is an absolute contraindication to using these medications. The other conditions listed—asthma, hypertension, and hyperlipidemia—are not absolute barriers to therapy with these drugs, so they do not carry the same contraindication.