Which condition is a major contraindication to ACE inhibitors?

• A. Hyperkalemia
• B. Pregnancy
• C. Hypotension
• D. Hyperlipidemia

Answer: (B)

ACE inhibitors are teratogenic and disrupt fetal kidney development by blocking the angiotensin II pathway, which is essential for fetal renal growth and amniotic fluid regulation. This can lead to fetal renal failure, oligohydramnios, growth restriction, and serious congenital abnormalities, especially with exposure in the latter part of pregnancy. Because of these fetal risks, pregnancy is a major contraindication to ACE inhibitors.

Hyperkalemia and hypotension can occur with ACE inhibitors as side effects, but they do not by themselves make the drug universally contraindicated in all patients. Hyperlipidemia is not related to the decision to avoid ACE inhibitors in pregnancy.