What Are ACE Inhibitors?

Angiotensin-converting enzyme (ACE) inhibitors are a class of drugs that leads to vasodilation, these drugs ultimately widen blood vessels to lower blood pressure, improve blood flow, and decrease the workload on the heart.^1-2 They do this by blocking an enzyme that causes blood vessels to constrict (narrow).¹ This helps improve blood flow and reduces the pooling of blood in the body.¹

Why are they prescribed?

They are prescribed for people with systolic heart failure (HF) caused by left ventricular dysfunction.¹ ACE inhibitors reduce the workload of the left ventricle by decreasing the pressure the heart has to pump against, thereby improving symptoms, helping people to feel better and live longer lives.² ACE inhibitors and angiotensin II receptor blockers, called ARBs, also affect the hormones that regulate fluids, particularly the salt and water balance of the body.¹ ACE inhibitors increase the elimination of these fluids into the urine, which lowers blood pressure.

ACE inhibitors are recommended for people with systolic HF who have symptoms and for those who are asymptomatic (without symptoms) as they can help reverse the damage done to the heart.¹ There are side effects to these medications. Your provider will check labs about a week after starting or changing the dose of this medication. People with elevated potassium levels, those who have had previous adverse reactions to ACE inhibitors, or who are pregnant should not take these drugs. Additionally, because they lower blood pressure, ACE inhibitors may not be the right type of medication for people with very low blood pressure. Similarly, these drugs can worsen kidney function in people with certain kinds of kidney problems caused by narrowed blood vessels (renal artery stenosis).¹

Treatment goals

Treatment goals of ACE inhibitors include improvement in heart function or delayed progression of heart failure, symptom relief, a decreased risk of hospitalization for heart failure, and decreased risk of death.¹

Commonly prescribed ACE inhibitors include:^2-3

• Lotensin® (benazepril)
• Capoten® (captopril)
• Vasotec® (enalapril)
• Monopril® (fosinopril)
• Prinivil®, Zestril® (lisinopril)
• Aceon® (perindopril)
• Accupril® (quinapril)
• Altace® (ramipril)
• Mavik® (trandolapril)
• Moexipril® (univasc)

There are different dosages for each of these formulations, and people with HF may be prescribed different dosages at different points to manage their symptoms.

Some ACE inhibitors are combined with a diuretic into one pill. These include:²

• Vaseretic® (enalapril and hydrochlorothiazide)
• Prinzide®, Zestoretic® (lisinopril and hydrochlorothiazide)
• Lotensin HCT (benazepril/HCTZ)
• Capozide HCT (captoprol/HCTZ)
• Monopril HCT (fosinopril/HCTZ)
• Accuretic (quinapril/HCTZ)
• Uniretic (moexipril/HCTZ)

Side effects

Common side effects of ACE inhibitors include a dry cough and headache. A more serious, but rare reaction is swelling of the lips/tongue (angioedema) which can be life-threatening. ACE inhibitors may have drug interactions with other medicines you are taking.¹ Be sure to mention to your provider if you take NSAIDs, antacids, potassium supplements, certain diuretics, or lithium before starting an ACE inhibitor.¹

As with most heart failure medications, your provider will order regular blood tests to monitor its effectiveness and any side effects.¹ It is important to take all medicines as prescribed. This will improve the effectiveness of the medication and may reduce any complications. If you have difficulty taking your medications, do not stop on your own, contact your health care team for assistance.

If you have trouble breathing, swelling in your face, lips, tongue or throat, or sudden chest pain call 911 or other emergency services or go directly to an emergency room.

These are not all the possible side effects of ACE inhibitors. Patients should talk to their doctor about what to expect with treatment with ACE inhibitors.