ACE inhibitors can treat a range of blood vessel diseases and potentially prevent serious heart health issues such as future heart attacks. They relax the blood vessels, enabling the heart to work less hard.

ACE enzyme leads to the conversion of angiotensin I to angiotensin II. Angiotensin II is a strong vasoconstrictor that narrows blood vessels and elevates blood pressure. There is also evidence that the narrowing of blood vessels can damage the kidneys, especially in people with diabetes.

ACE inhibitors block the action of ACE enzyme, helping the blood vessels to relax and widen. Most people tolerate these drugs well and have few interactions, so they are often a doctor’s first choice of treatment.

Read on to learn about ACE inhibitors for heart disease.

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ACE inhibitors can reduce blood pressure and lower the heart’s workload. They are the most common medications that doctors prescribe for a variety of different heart and kidney diseases, including:

Some examples of ACE inhibitors include:

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

Doctors prescribe a variety of different ACE inhibitors. Some, such as perindopril, are long-acting. This means a person takes them only once per day. Other drugs, such as captopril, are short-acting, requiring a person to take them several times daily.

The dosages vary, too. Doctors often start people at low doses and then gradually increase doses on the basis of the results.

A person should take the ACE inhibitor according to the prescriber’s instructions for the best benefit.

The most common side effects include:

  • a dry cough in 1–10% of people who take ACE inhibitors
  • angioedema, which is swelling in the deep layers of skin, including potentially around organs
  • a decline in kidney function that may reverse when a person stops taking the drug
  • hyperkalemia, which is dangerously high potassium
  • a dangerous drop in blood pressure, which may cause dizziness, confusion, and low energy
  • hepatitis and life threatening allergic reactions, although this is rare

People with a sensitivity or allergy to ACE inhibitors should not take these drugs.

Compared to many other heart medications, ACE inhibitors have few drug interactions. However, it is important to tell a doctor about all medications a person takes, including supplements and over-the-counter drugs.

Some potential interactions include:

  • Nonsteroidal anti-inflammatory drugs: These drugs may increase the risk of kidney damage.
  • Diuretics: These drugs may cause blood pressure to drop too low.
  • Lithium: ACE inhibitors may increase the risk of lithium poisoning.

This is not necessarily a list of all possible interactions because researchers cannot test every possible drug combination.

ACE inhibitors may also increase blood potassium levels, so taking potassium supplements may cause harmful interactions. A person should speak with a doctor before taking any supplements to ensure it is safe to do so.

ACE inhibitors are in the Food and Drug Administration’s category D for pregnancy. This denotes clear, identified risks to the pregnant person or fetus. A person should not take ACE inhibitors when pregnant and should stop taking them as soon as they become pregnant.

The risks of ACE inhibitors during pregnancy include:

  • skull and skeletal abnormalities in the developing fetus
  • death
  • oligohydramnios, which means dangerously low amniotic fluid
  • kidney damage
  • lung underdevelopment in the developing fetus

A person should speak with a doctor about any concerns relating to heart disease during pregnancy.

Heart disease is fairly uncommon in children, so fewer children than adults take ACE inhibitors. However, children can take these drugs. Lisinopril (Zestril), for example, has approval for treating high blood pressure in children over six years old.

Depending on a child’s specific needs and risk factors, doctors may choose from a wide range of drugs to treat high blood pressure.

ACE inhibitors are a group of drugs that relax blood vessels, lowering the risk of several heart health issues and helping to reduce the complications of heart and kidney disease. Most people tolerate these drugs well and they have few interactions with other treatments, so they are often a doctor’s first choice.

However, any drug can cause side effects, and ACE inhibitors may cause low blood pressure. It is important to tell a doctor about any medications a person takes and to report any side effects to a doctor promptly.