Which combination lists the three contraindications for using an ACE inhibitor?

• A. Bilateral renal artery stenosis, history of angioedema, pregnancy
• B. Hypertension without renal disease
• C. Hyperlipidemia
• D. Hypokalemia

Answer: (A)

ACE inhibitors block angiotensin-converting enzyme, so they are avoided when blocking this pathway could harm kidney function, fetal development, or trigger severe allergic-type reactions. The three true contraindications are: bilateral renal artery stenosis, because angiotensin II helps maintain glomerular filtration; removing it can precipitate acute kidney injury. A history of angioedema, especially related to ACE inhibitors, signals a high risk of recurrent, potentially life-threatening swelling if the drug is used again. And pregnancy, since ACE inhibitors can cause fetal renal damage and other serious congenital issues.

Other scenarios listed aren’t absolute contraindications: hypertension without renal disease can still be treated with ACE inhibitors, hyperlipidemia isn’t a direct reason to avoid them, and hypokalemia isn’t a contraindication (ACE inhibitors tend to raise potassium, so monitoring potassium is important, but low potassium itself isn’t a blanket reason to avoid them).