**Question:** Which one of the following is not an adverse effect of ACE inhibitors?

A. Hypotension
B. Dyspepsia
C. Increased urination
D. GI bleeding

**Core Concept:** Angiotensin-converting enzyme (ACE) inhibitors are a class of medications commonly used in the treatment of hypertension and heart failure. They inhibit the conversion of angiotensin I to angiotensin II, which leads to vasodilation and reduced aldosterone secretion, ultimately decreasing blood pressure and improving heart function.

**Why the Correct Answer is Right:** Hypotension is an adverse effect of ACE inhibitors as they lower blood pressure by inhibiting the renin-angiotensin-aldosterone system (RAAS). ACE inhibitors cause a decrease in vasoconstriction, which results in reduced blood pressure.

**Why Each Wrong Option is Incorrect:**

- Dyspepsia (Option B) is a side effect of ACE inhibitors, not an adverse effect. ACE inhibitors are known to cause gastrointestinal side effects like dyspepsia, dry cough, and angioedema.
- Increased urination, also known as polyuria, is a common side effect of ACE inhibitors due to their effect on the renin-angiotensin-aldosterone system (RAAS). ACE inhibitors decrease angiotensin II levels, leading to decreased aldosterone secretion, which in turn results in increased urine production.
- GI bleeding (Option D) is a rare but serious side effect of ACE inhibitors. While some ACE inhibitors may increase the risk of GI bleeding, this option may be considered wrong due to its rarity compared to the other options.

**Clinical Pearl:** In clinical practice, it is essential to monitor patients on ACE inhibitors for signs of hypotension, particularly in those with pre-existing low blood pressure or those on concomitant medications that may lower blood pressure, such as calcium channel blockers or diuretics. This monitoring helps to adjust the dosage and ensure patient safety.