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Jul 19, 2022

Blood Pressure

Heart Health

Blood PressureACE inhibitorsHypertension

Angiotensin-Converting Enzyme (ACE) Inhibitors

Suppose you struggle with hypertension (high blood pressure), and/or a variety of other cardiovascular conditions, such as heart failure. In that case, angiotensin-converting enzyme (ACE) inhibitors may be the right drug class for you.

ACE Inhibitors

Angiotensin-converting enzyme (ACE) inhibitors are used to help lower blood pressure by relaxing your veins and arteries. They are a drug class of medications that typically end in “- pril”

How ACE affect blood pressure

What is angiotensin-converting enzyme (ACE)?

Angiotensin (an-gee-oh-ten-sin)-converting enzyme is part of the renin-angiotensin-aldosterone system (RAAS): a hormone system that controls blood pressure. ACE converts angiotensin I to angiotensin II, which causes blood vessels to constrict therefore increasing blood pressure.

ACE raises blood pressure in a couple of ways:

  • By converting angiotensin I to angiotensin II
    1. Angiotensin II causes veins and arteries to narrow, making your heart work harder.
    2. Angiotensin II stimulates aldosterone production in adrenal glands. Aldosterone (al-DOS-teh-rone) is a steroid hormone that controls the balance of water and salt in the kidney. Too much aldosterone can cause high blood pressure.
  • By breaking down bradykinin
    1. Bradykinin (bray-dee-ky-nin) is a protein that lowers blood pressure by relaxing blood vessels. Breakdown of bradykinin makes your blood pressure go up.

How do ACE Inhibitors Work?

ACE inhibitor blocks angiotensin I from producing angiotensin II. When ACE inhibitors block the conversion of angiotensin I to II, this results in vasodilation (widening of your blood vessels) and a decrease in aldosterone secretion. ACE inhibitors also block the degradation of bradykinin, a protein that helps your kidneys remove sodium from your body and reduces blood pressure by relaxing your blood vessels. Bradykinin is broken down by the enzyme called ACE. Your blood pressure increases when there is less bradykinin available.

What are ACE Inhibitors Used For?

ACE inhibitors are used to prevent, treat and/or improve symptoms in conditions such as high blood pressure, heart failure, heart attack, CAD, CKD, diabetes and migraines.

Hypertension (high blood pressure)

ACE inhibitors prevent the enzyme angiotensin I from producing angiotensin II, which is a substance that constricts/narrows your blood vessels, essentially decreasing your blood pressure.

Heart failure

Also referred to as congestive heart failure, is a medical condition that occurs when your heart doesn’t pump enough blood for your body’s needs.

Your blood arteries are dilated by ACE inhibitors, which increase blood flow. The work that your heart has to undertake is reduced as a result. This drug class also aids in blocking the enzyme angiotensin, which is produced as a result of heart failure.

ACE inhibitors can also help individuals with heart failure live longer.

Heart attack

Also referred to as myocardial infarction (MI), is a medical condition that involves the destruction or death of a section of your heart muscle (myocardium) as a result of a blocked blood supply.

ACE inhibitors help decrease your blood pressure and reduce the workload on your heart, which decreases the chances of a heart attack and/or stroke.

When ACE inhibitors are given after a heart attack, they may decrease the impact on your heart strength and help you live longer.

Coronary artery disease (CAD)

A medical condition where your coronary arteries constrict or get blocked (blood vessels that carry blood and oxygen to your heart). Atherosclerosis is typically the cause of coronary artery disease (a buildup of fatty material and plaque inside your coronary arteries).

ACE inhibitors inhibit the angiotensin-converting enzyme (ACE - the enzyme responsible for converting angiotensin I to angiotensin II) and block the production of angiotensin II, preventing cardiac remodeling (changes in your heart’s size and/or shape) and decreasing preload (the filling pressure of your heart at the end of diastole) and afterload (ventricle wall tension during contraction/the pressure that your heart must work against to eject blood during systole).

ACE inhibitors are typically taken for life in individuals with CAD.

Chronic kidney disease (CKD)

A medical condition that involves a progressive loss of kidney function over time.

ACE inhibitors inhibit the renin-angiotensin-aldosterone system (RAAS), a mechanism that regulates your blood pressure and cardiovascular function, causing efferent arteriolar (an arteriole that delivers blood away from the capillaries of the kidney) dilation.

ACE inhibitors are considered first-line medications to prevent the progression of diseases such as CKD, diabetes, and/or hypertension if albuminuria (a primary protein that’s measured in the urine to assess kidney disease) is present.


A chronic medical condition characterized by abnormally high blood sugar glucose levels.

ACE inhibitors have been shown to prevent or mitigate kidney damage. Diabetes can damage the blood vessels in your kidneys. Your kidneys can also be harmed by high blood pressure.


Headaches on one or both sides of the head that flare up periodically

What are Examples of ACE Inhibitors?

Examples of ACE inhibitors include:

  1. Benazepril (Lotensin) 5–40 mg daily   Order Benazepril
  2. Captopril 12.5–100 mg BID (twice a day)
  3. Enalapril (Vasotec) 5–20 mg daily or BID    Order Enalapril
  4. Fosinopril 10–40 mg daily
  5. Lisinopril (Prinivil, Zestril) 5–40 mg daily    Order Lisinopril
  6. Moexipril 3.75–30 mg daily
  7. Perindopril 4–16 mg daily
  8. Quinapril (Accupril) 5–40 mg daily    Order Quinapril
  9. Ramipril (Altace) 2.5–20 mg daily    Order Ramipril
  10. Trandolapril 1–8 mg daily

An ACE inhibitor may occasionally be taken along with another blood pressure medication, such as a diuretic or calcium channel blocker.

Angiotensin receptor blockers and direct renin inhibitors should not be administered with ACE inhibitors.

What are the Side Effects of ACE Inhibitors?

Common adverse effects of these medications include:
  • Dry cough
    This is a very common side effect that’s caused by all ACE inhibitors due to blocking the degradation of bradykinin. It may disappear for some individuals over time. However, if this symptom persists or is severe, contact your healthcare provider.
  • Dizziness
    All blood pressure drugs frequently cause this due to your blood pressure going too low. After starting an ACE inhibitor, avoid getting up too quickly. Standing up too quickly can make you feel dizzy or pass out.
  • Headaches
  • Red, itchy skin, and/or rash
  • Feeling fatigued
  • Weakness
  • Drowsiness

Severe side effects of ACE inhibitors include:

  • Angioedema
    Your face, eyes, mouth, lips, tongue, neck, as well as your legs, feet, or hands, may swell.
    You should get medical assistance right away if you experience this kind of swelling in your face, lips, and/or throat.
  • Hyperkalemia
    ACE inhibitors may increase the amount of potassium in your body.
    Do not use salt substitutes or potassium supplements while taking this medication, unless your healthcare provider has told you to do so.
    Confusion, irregular heartbeat, nervousness, tingling or numbness in your hands, feet, or lips, shortness of breath or difficulty breathing, and weakness or heaviness in your legs are symptoms of having an excessive amount of potassium in your body.
    If you experience any of these symptoms, speak with your doctor straight away.
  • Jaundice—Yellowing of the skin or the whites of your eyes, which could indicate major liver issues.
  • Hypotension—Low blood pressure.
  • Renal impairment—Although ACE inhibitors aid in kidney protection, some individuals may develop renal failure (kidney failure) as a result of taking these medications.

Do ACE Inhibitors Interact with Other Medications?

Avoid using OTC (over-the-counter) medications such as nonsteroidal anti-inflammatory medications (NSAIDs), Aleve, and/or Motrin. These medications may reduce the effects of ACE inhibitors and cause your body to retain sodium and water. Before taking any anti-inflammatory drugs, speak with your healthcare provider.

Avoid using an ACE inhibitor with sacubitril/valsartan (Entresto). If switching from an ACE inhibitor to Entresto, or vice versa, a 36-hour washout period is required.

The use of an ACE inhibitor with aliskiren (Tekturna), is specifically contraindicated in individuals with diabetes due to the increased risk of renal impairment, hypotension, and hyperkalemia.

What Should I Do if I Miss a Dose?

If you forget to take a dose, take it as soon as you remember unless it's almost time for your next dose. In this case, skip the forgotten dose and take the next one at the usual time. Do not take 2 doses together to make up for a missed dose.

What Should I Look Out For When Taking an ACE Inhibitor?

Black Boxed Warning ACE inhibitors contain a black box warning (the strictest warnings for prescriptions) alerting that this drug class can cause injury and death to a developing fetus when used in the 2nd or 3rd trimester of pregnancy. This drug class should be discontinued as soon as a pregnancy is detected.

Get emergency medical help if you have any of the signs of an allergic reaction while taking an ACE inhibitor: hives, difficulty breathing, or swelling of your face, lips, tongue, and/or throat.

Speak With Your Doctor

ACE inhibitors are widely accessible. Your overall health and pre-existing condition are just 2 factors that affect which option is best for you.

Talk to your healthcare provider about using ACE inhibitors and send your prescription to Marley Drug. Save up to 95% compared to your local pharmacy by using Marley Drug.

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