Angiotensin-converting enzyme inhibitors (ACE inhibitors) are a group of medicines that are mainly used to treat certain heart and kidney conditions; however, they may be used in the management of other conditions such as migraine and scleroderma.
They block the production of angiotensin II, a substance that narrows blood vessels and releases hormones such as aldosterone and norepinephrine, by inhibiting an enzyme called angiotensin converting enzyme. Angiotensin II, aldosterone, and norepinephrine all increase blood pressure and urine production by the kidneys. If levels of these three substances decrease in the body, this allows blood vessels to relax and dilate (widen), reducing both blood and kidney pressure. ACE inhibitors also increase the production of bradykinin, another substance that makes blood vessels dilate.
What are ACE inhibitors used for?
ACE inhibitors may be used for the treatment of the following conditions:
- Certain chronic kidney conditions (but not others)
- Coronary artery disease
- Heart failure
- High blood pressure
- Prevention of migraines
- Scleroderma
- To reduce the risk of complications following a heart attack (myocardial infarction)
- To reduce the risk of kidney disease (diabetic nephropathy) in people with diabetes.
They may also be used for other conditions not listed here.
What are the differences between ACE inhibitors?
ACE inhibitors all work in the same way; by inhibiting the action of the angiotensin converting enzyme.
However, there are differences in their effectiveness at reducing blood pressure, their side effect profile, and their ability to prevent people from dying from a heart-related or other cause.
|
Generic name |
Examples of brand names |
|
benazepril |
Lotensin |
|
captopril |
Generic |
|
enalapril |
Epaned, Vasotec |
|
fosinopril |
Generic |
|
lisinopril |
Prinivil, Zestril |
|
moexipril |
Generic |
|
perindopril |
Generic |
|
quinapril |
Accupril |
|
ramipril |
Altace |
|
trandolapril |
Generic |
Are ACE inhibitors considered safe?
When taken at the recommended dosage, ACE inhibitors are considered safe. However, they have been associated with several serious adverse effects including:
- Fetal harm and death: ACE inhibitors are not recommended for use during pregnancy and should be discontinued as soon as possible if a pregnancy inadvertently occurs. They can adversely affect a developing baby’s kidneys or cause miscarriage, particularly when taken during the second and third trimester
- Angioedema of the head, neck, or intestines: This is a skin reaction characterized by an acute and short-lived swelling of the lower layer of skin and tissue just under the skin or mucous membranes. When it involves the tongue or throat area this may result in severe breathing difficulties. Angioedema is more common in people who smoke and in African-Americans
- Potentially life-threatening allergic reactions (anaphylactoid reactions): These have most commonly occurred during desensitization therapy or associated with dialysis.
What are the side effects of ACE inhibitors?
Some of the more commonly reported side effects with ACE inhibitors include:
- A dry persistent cough
- Blurred vision
- Dizziness
- Dry mouth or loss of taste in the mouth
- Fatigue
- Gastrointestinal upset (such as constipation, diarrhea, or nausea)
- Headache
- Increased blood levels of potassium and creatinine
- Low blood pressure or a drop in blood pressure, particularly when going from a lying to standing position (more common in people who are dehydrated)
- Sweating.
ACE inhibitors may be less effective at lowering blood pressure in patients of African-American descent compared to those without this ethnicity.
For a complete list of side effects, please refer to the individual drug monographs.
ACE inhibitors can also interact with several other medications (including NSAIDs and lithium). Consult your prescribing doctor before taking any other medications including those brought over the counter.
