ACE inhibitors

ACE inhibitors, short for angiotensin-converting enzyme inhibitors, are a group of prescription medications used mainly to treat high blood pressure and heart failure. They are also commonly used to help protect the kidneys in people with certain types of chronic kidney disease, especially those linked to diabetes. ACE inhibitors help lower blood pressure, reduce strain on the heart, and lower the risk of heart attack and long-term cardiovascular disease. These medications have been used for decades and are often considered a first-line treatment for hypertension based on clinical practice guidelines from major groups like the AHA.

ACE inhibitors work by relaxing the blood vessels, which makes it easier for blood to flow. This helps lower blood pressure and reduces the workload on the heart. For many people, ACE inhibitors are a key part of managing risk factors like hypertension, heart disease, and kidney disease. Common ACE inhibitors include lisinopril, enalapril, captopril, ramipril, benazepril, fosinopril, trandolapril, perindopril, quinapril, moexipril, and others. Many of these medications are known by brand names like Zestril, Prinivil, Vasotec, Lotensin, Accupril, and Mavik.

ACE inhibitors may be prescribed alone or together with other blood pressure medications such as diuretics, calcium channel blockers, or angiotensin receptor blockers (ARBs), depending on your healthcare provider’s treatment plan. These medications are widely used to lower blood pressure, reduce the risk of heart attack, support kidney function, and prevent long-term complications linked to high blood pressure and cardiovascular disease.

ACE inhibitors are prescription medications used to lower blood pressure, treat heart failure, and protect kidney function in certain individuals. They help manage hypertension, reduce cardiovascular risks, and slow the progression of chronic kidney disease.

The active ingredient in ACE inhibitors varies depending on the specific medication. ACE inhibitors block the angiotensin-converting enzyme (ACE), which is responsible for turning angiotensin I into angiotensin II. Angiotensin II is a strong chemical that causes blood vessels to tighten. When the blood vessels tighten, blood pressure rises, the heart works harder, and the body holds onto more water and salt. By lowering the amount of angiotensin II in the body, these drugs cause vasodilation, meaning the blood vessels relax. This helps lower blood pressure, improve blood flow, and reduce strain on the heart.

ACE inhibitors also lower levels of bradykinin breakdown, which can help with vasodilation but may also cause a dry cough, one of the most common side effects of ACE inhibitors. These medications also reduce proteinuria and slow the progression of kidney damage in many people with chronic kidney disease, especially those with diabetic nephropathy. Because ACE inhibitors help reduce pressure inside the kidneys’ glomerular blood vessels, they help protect long-term kidney function.

Overall, ACE inhibitors work by lowering blood pressure, easing strain on the heart, improving blood flow, and slowing kidney disease progression. These effects help lower the risk of heart attack, heart failure, and long-term cardiovascular disease.

Common ACE inhibitors include:

• Zestril (lisinopril).
• Prinivil (lisinopril).
• Vasotec (enalapril).
• Capoten (captopril).
• Altace (ramipril).
• Lotensin (benazepril).
• Monopril (fosinopril).
• Mavik (trandolapril).
• Aceon (perindopril).
• Accupril (quinapril).
• Univasc (moexipril).

They are used to treat high blood pressure, heart failure, protect kidney function in certain cases of chronic kidney disease, and reduce the risk of heart attack and cardiovascular complications.

Some mild or common side effects of ACE inhibitors seen in clinical trials as compared to placebo include:

• Dry cough.
• Dizziness or lightheadedness.
• Headache.
• Low blood pressure (hypotension).
• Fatigue.
• Changes in taste.
• Constipation.

Some individuals may experience serious side effects while using ACE inhibitors. These side effects may require immediate medical attention. If you experience any of the following, contact your healthcare provider or seek emergency medical help:

• Swelling of the face, lips, tongue, or throat (angioedema), which can be life-threatening.
• Severe dizziness or fainting.
• Signs of kidney damage, such as rapid changes in kidney function.
• Increased potassium levels (hyperkalemia).
• Signs of an allergic reaction, such as difficulty breathing or rash.
• Symptoms of kidney failure such as little or no urine output.
• Serious drops in blood pressure.

These are not all of the possible side effects of ACE inhibitors. You should always seek medical advice from your healthcare provider for any questions or concerns about your medical condition or treatment. Read all patient information, medication guides, or drug information sheets that come with this medication. You can also report adverse effects to the Food and Drug Administration at www.fda.gov/medwatch or 1-800-FDA-1088.

Although these medications are generally well-tolerated and safe, there are certain warnings, precautions, and drug interactions you should be aware of.

Warnings

Before starting ACE inhibitors, it is crucial to discuss any existing health conditions with your healthcare provider. You should be sure that your healthcare provider is aware of all your medical conditions, including if you have:

• Kidney disease or reduced kidney function.
• A history of angioedema.
• Low blood pressure (hypotension) or dehydration.
• Liver disease.
• High potassium levels.
• Coronary artery disease or heart failure.
• Renal artery stenosis.
• A history of allergic reactions to any ACE inhibitor.
• Diabetes.
• Any medications you take, including NSAIDs like Motrin, supplements, and over-the-counter products.

Your doctor may adjust your dose based on blood tests that measure kidney function, potassium levels, ALT levels, and other electrolytes. Because ACE inhibitors can affect the kidneys, your doctor will monitor creatinine and potassium levels closely when you begin therapy or increase your dose.

Boxed Warning

• ACE inhibitors must not be used during pregnancy. These medications can cause injury or death to an unborn baby. If you become pregnant while taking an ACE inhibitor, stop the medication right away and contact your healthcare provider. ACE inhibitors should not be used at any time during pregnancy.

Contraindications

ACE inhibitors should not be used in people who:

• Have a history of angioedema linked to ACE inhibitors.
• Have hereditary or idiopathic angioedema.
• Are pregnant or planning to become pregnant.
• Have severe kidney dysfunction linked to ACE inhibitor use.
• Are taking aliskiren for diabetes.
• Have known hypersensitivity to any ACE inhibitor.

Drug Interactions

When ACE inhibitors are taken with other prescription drugs, over-the-counter medications, vitamins, and supplements, it may change how they work or increase the frequency or severity of side effects. Make sure that you tell your healthcare professional about anything that you are taking to avoid any negative drug interactions, including:

• NSAIDs such as Motrin.
• Potassium-sparing diuretics.
• Lithium.
• Over-the-counter (OTC) cold medicines.
• Supplements that affect potassium levels.

Some interactions can lead to kidney damage, changes in blood pressure, or dangerously high potassium levels.