
Angiotensin-converting enzyme (ACE) inhibitors are a group of medications indicated for the treatment of hypertension (high blood pressure).
- ACE inhibitors work by causing the kidneys to reduce the secretion of a substance called ACE, ultimately causing relaxation and widening of the blood vessel walls and reduction in blood pressure.
- ACE inhibitors are prescribed as the first-line treatment of hypertension, especially in patients with heart disorders such as heart failure, both ST elevation, and non-ST elevation myocardial infarction, and in patients with chronic kidney disease with proteinuria (an abnormal condition in which high protein levels are seen in the urine).
Although ACE inhibitors are considered the first line of treatment for hypertension, they may be given in combination with other groups of antihypertensive agents such as diuretics, calcium channel blockers, angiotensin II receptor blockers, or direct renin inhibitors.
Random clinical trials done on participants show that no ACE inhibitor medicine appears to be better or worse than others in terms of blood pressure-reducing ability. However, several other studies conducted on ACE inhibitors reported that:
- Trandolapril is more successful in lowering both systolic and diastolic blood pressure.
- Enalapril effectively reduces blood pressure because it simultaneously improves heart function. However, it is associated with side effects such as increased cough, gastrointestinal discomfort, and impairment of kidney function in higher doses.
- Ramipril was linked to the lowest risk of death from any cause.
- Lisinopril was the least effective in blood pressure control and is associated with a high risk of death. However, it was effective in reducing albumin excretion in the urine in patients with diabetes.
- The U.S. Food and Drug Administration approved captopril for diabetic nephropathy.
What are the examples of ACE inhibitors?
Drugs that come under the group angiotensin-converting enzyme (ACE) inhibitors include:
- Lisinopril
- Enalapril
- Benazepril
- Trandolapril
- Fosinopril
- Ramipril
- Moexipril
- Quinapril
- Captopril
Except for captopril and lisinopril, all other drugs are prodrugs.
Prodrugs are drugs in their inactive form that have to be converted into their active forms in the body. This activation of prodrugs takes place in the liver. This implies that patients with liver anomalies are given active drugs such as captopril and lisinopril for the management of hypertension.
Some ACE inhibitors are metabolized by the liver and a few by the kidneys. Therefore, ACE inhibitors given may vary from patient to patient and are given according to their health conditions.
How do ACE inhibitors work?
As the name suggests, angiotensin-converting enzyme (ACE) inhibitors inhibit an enzyme named ACE and interfere with the renin-angiotensin–aldosterone system (RAAS), which plays a major role in maintaining blood pressure in the body.
- ACE converts the hormone angiotensin I to its active form—angiotensin II—in the body.
- Hormone angiotensin II acts on the blood vessels and causes narrowing of the vessels (vasoconstriction).
- Narrowing of the blood vessels caused by angiotensin II increases blood pressure.
- Moreover, angiotensin II stimulates the release of another hormone—aldosterone.
- Aldosterone is an antidiuretic hormone that increases the reabsorption of water and salt by the kidney. This increases in blood volume and eventually increases blood pressure.
ACE inhibitors prevent the conversion of angiotensin I to angiotensin II, increasing the elimination of excess water and salt through the urine. With decreased blood volume, the cardiac output and stroke volume decrease, resistance in the renal blood vessels reduce, and venous capacity increases.
Bradykinin is another chemical that causes the blood vessels to widen (vasodilation). ACE participates in the breakdown of bradykinin. ACE inhibitors prevent the breakdown of bradykinin that resulting in high bradykinin levels, leading to dilation of the blood vessels.

SLIDESHOW
How to Lower Blood Pressure: Exercise and Tips See SlideshowWhat are the uses of ACE inhibitors?
Apart from hypertension, angiotensin-converting enzyme inhibitors have been indicated to prevent, treat, or improve symptoms of various conditions, such as:
- Congestive heart failure
- Coronary artery disease
- Reduce the risk of complications post-myocardial infarction
- Chronic kidney disease
- Reduce the risk of diabetic nephropathy
- Diabetes
- Migraines
- Scleroderma
- Early death caused by hypertension
What are the side effects of ACE inhibitors?
Angiotensin converting enzyme (ACE) inhibitors are usually considered safe when taken in recommended doses. However, there are some side effects associated with them, which include:
- Dry cough, which may become chronic and last up to a month
- Hyperkalemia (high serum potassium levels)
- Weakness
- Drowsiness
- Dizziness
- Headache
- Nausea
- Constipation
- Diarrhea
- Decrease in blood pressure
- Fatigue
- Changes in taste
- Loss of taste or dry mouth
- Metallic or salty taste
- Chest pain
- Increased serum uric acid levels
- Increased blood urea nitrogen and creatinine levels
- Sensitivity to sun
- Blurred vision
A few serious side effects associated with ACE inhibitors may include:
- Kidney failure
- Life-threatening allergic reactions
- Angioedema (swelling) of the neck, head, or intestines
- angioedema in the tongue and throat may be life-threatening
- Risk of fetal developmental abnormalities or miscarriage as seen in pregnant women who are on ACE inhibitors
- do not take these drugs or discontinue them during pregnancy
Health News
- FDA Panel Backs RSV Vaccine for Infants, Some Toddlers
- Seniors: Stay Social, Active for 'Optimal Aging,' Study Shows
- Diabetes Med Metformin Might Help Prevent Long COVID
- Disability a Growing Concern for U.S. Cancer Survivors
- Smoke From Wildfires Is Especially Tough If You Have Asthma. Here’s How to Protect Yourself
More Health News »
Health Solutions From Our Sponsors
ACE inhibitors for the treatment of high blood pressure: https://www.cochrane.org/CD003823/HTN_ace-inhibitors-for-the-treatment-of-high-blood-pressure
Pharmacologic Management of Hypertension in Patients with Diabetes: https://www.aafp.org/afp/2008/1201/p1277.html
Comparison of the Efficacy and Safety of Different ACE Inhibitors in Patients With Chronic Heart Failure: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4753869/#:~:text=CONCLUSION-,When%20considering%20factors%20such%20as%20increased%20ejection%20fraction%2C%20stroke%20volume,the%20most%20effective%20ACE%20inhibitor.
Top Which ACE Inhibitor Is the Best for Hypertension Related Articles
Can Blood Pressure Spike For No Reason?
It is normal for your blood pressure to rise and fall throughout the day. Your blood pressure can fluctuate at any time due to various reasons.High Blood Pressure (Hypertension)
High blood pressure (hypertension) is a disease in which pressure within the arteries of the body is elevated. About 75 million people in the US have hypertension (1 in 3 adults), and only half of them are able to manage it. Many people do not know that they have high blood pressure because it often has no has no warning signs or symptoms.
Systolic and diastolic are the two readings in which blood pressure is measured. The American College of Cardiology released new guidelines for high blood pressure in 2017. The guidelines now state that blood normal blood pressure is 120/80 mmHg. If either one of those numbers is higher, you have high blood pressure.
The American Academy of Cardiology defines high blood pressure slightly differently. The AAC considers 130/80 mm Hg. or greater (either number) stage 1 hypertension. Stage 2 hypertension is considered 140/90 mm Hg. or greater.
If you have high blood pressure you are at risk of developing life threatening diseases like stroke and heart attack.
REFERENCE: CDC. High Blood Pressure. Updated: Nov 13, 2017.
High Blood Pressure & Body
High blood pressure puts you at risk for a number of other conditions. Here's what to look out for.HBP Quiz
Take this quiz and test your IQ of high blood pressure (hypertension), the cardiovascular disease that causes most strokes and heart attacks. How are dizziness, snoring, and gout related to HBP? Find the answer and learn how medical treatments and lifestyle adjustments fight this common problem.How Can I Bring My Blood Pressure Down Immediately?
High blood pressure is diagnosed when the force of your blood pressing against the artery wall is too high for an extended period of time. Bring your blood pressure down immediately by taking a hot shower or bath and practicing deep breathing and relaxation techniques.How Is Diastolic Hypertension Treated?
Diastolic hypertension, where only your diastolic blood pressure is elevated, may be treated with lifestyle changes such as weight loss, reducing your sodium intake or alcohol consumption, and quitting smoking. Medications may be prescribed in more severe cases.Hypertension Picture
High blood pressure, defined as a repeatedly elevated blood pressure exceeding 140 over 90 mmHg -- a systolic pressure above 140 with a diastolic pressure above 90. See a picture of Hypertension and learn more about the health topic.15 Surprising Things That Raise Your Blood Pressure
Salt, worry, and anger aren't the only things that can raise your blood pressure. Risk factors like loneliness and birth control may also affect blood pressure. See what else can bump your numbers up.Hypertension: Worst Foods for High Blood Pressure
Diagnosed with high blood pressure or trying to avoid it? Stay away from these foods.Hypertension-Induced Chronic Kidney Disease
Hypertension-induced chronic kidney disease (CKD) is a long-standing kidney condition that develops over time due to persistent or uncontrolled high blood pressure (hypertension).Is Angioedema Serious?
Angioedema is swelling under your skin due to fluid leaking from your blood vessels. Angioedema doesn't cause damage to your internal organs, but it can be life-threatening if your tongue or throat swells up badly and causes breathing problems.Pulmonary Hypertension
Pulmonary hypertension is elevated pressure in the pulmonary arteries that carry blood from the lungs to the heart. The most common symptoms are fatigue and difficulty breathing. If the condition goes undiagnosed, more severe symptoms may occur. As pulmonary hypertension worsens, some people with the condition have difficulty performing any activities that require physical exertion. While there is no cure for pulmonary hypertension, it can be managed and treated with medications and supplemental oxygen to increase blood oxygen levels.What Are the Side Effects of Telmisartan?
Telmisartan is an oral tablet sold under the brand name "Micardis," available as both the brand name and generic name. Telmisartan side effects include fatigue, nausea, headache, and others.What Is High Blood Pressure (Hypertension)?
High blood pressure or hypertension is when the blood pressure readings consistently range from 140 or higher for systolic or 90 or higher for diastolic. Blood pressure readings above 180/120 mmHg are dangerously high and require immediate medical attention.Why Does Alcohol Cause Hypertension?
Alcoholic beverages are regular drinks in most parts of the world. No one knows how alcohol causes hypertension, but it may be due to the effects of alcohol endothelium, nervous system, cortisol levels or other body systems.