Table of ContentsView AllTable of ContentsUsesHow they WorkPrecautionsTaking and StoringSide EffectsWarnings
Table of ContentsView All
View All
Table of Contents
Uses
How they Work
Precautions
Taking and Storing
Side Effects
Warnings
Angiotensin-converting enzyme(ACE) inhibitors are oral medications that lower blood pressure. They are used to treat a variety of heart-related conditions includinghigh blood pressure,coronary artery disease, andheart failure. They are also used to help control the progression ofdiabetesandkidney disease.
This article looks at ACE inhibitors, their uses, precautions, and contraindications. It also discusses how to take and store ACE inhibitors, and what some of the side effects might be.
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How ACE Inhibitors Are Used
ACE inhibitors were approved for treating hypertension in 1981.Over time, ACE inhibitor use has expanded dramatically to treat cardiovascular disease and related conditions.
Diabetes and heart disease often occur together.High blood pressureis very common in people with diabetes. It can also contribute to the development of a kind of kidney disease calleddiabeticnephropathy.
Heart problems in people with diabetes tend to lead to longer hospitalizations, longer recovery times, and higher risks of infection. For this reason, healthcare providers usually treat hypertension in concert with diabetes.
Can Diabetes Cause High Blood Pressure?
ACE inhibitors don’t directly lower blood sugar, but they can contribute to blood sugar control. This is because they increase the body’s sensitivity toinsulin. Insulin helps you metabolize glucose (sugar) and move it from the bloodstream into cells. Once in the cells, it acts as a source of energy.
ACE inhibitors have also been shown to have additional benefits for people with diabetes and those at risk for diabetes. These include:
Many ACE inhibitors are available in the United States. Examples include:
“Off-Label” Uses
For example, ACE inhibitors are sometimes used to help controlabnormal heart rhythms, particularly after a heart attack. They may also be used off-label to treat diseases like:
How ACE Inhibitors Work
ACE inhibitors stop the body from producing a hormone called angiotensin II.Angiotensin II causes narrowing of blood vessels and fluid retention. This can lead to hypertension.
ACE Inhibitors vs. Beta Blockers: How Are They Different?
Precautions and Contraindications
You should not take ACE inhibitors if:
If you have significantkidney damage, you will likely need adjusted dosing of ACE inhibitors.
ACE inhibitors can harm a fetus or infant. For this reason, people who are pregnant, trying to conceive, or breastfeeding should not use them.If you do become pregnant while taking an ACE inhibitor, let your healthcare provider know so you can switch to a different medication right away.
ACE Inhibitors and Common Pain RelieversNSAIDs make ACE inhibitors less effective. If you take NSAIDs regularly or even occasionally, talk to your healthcare provider about other medication options.NSAIDs also increase the risk of kidney damage and unusually high potassium levels (called hyperkalemia). Taking them once in a while may not be a problem, but ask your healthcare provider first and always take as small a dose as possible.
ACE Inhibitors and Common Pain Relievers
NSAIDs make ACE inhibitors less effective. If you take NSAIDs regularly or even occasionally, talk to your healthcare provider about other medication options.NSAIDs also increase the risk of kidney damage and unusually high potassium levels (called hyperkalemia). Taking them once in a while may not be a problem, but ask your healthcare provider first and always take as small a dose as possible.
NSAIDs make ACE inhibitors less effective. If you take NSAIDs regularly or even occasionally, talk to your healthcare provider about other medication options.
NSAIDs also increase the risk of kidney damage and unusually high potassium levels (called hyperkalemia). Taking them once in a while may not be a problem, but ask your healthcare provider first and always take as small a dose as possible.
How to Take and Store
ACE inhibitor dosing varies depending on other medications you may be taking. Some ACE inhibitors should be taken with food. Always check the directions before taking your first dose.
ACE inhibitors should be stored according to the package instructions. This generally means keeping them in a cool, dry place, like a cupboard or medicine cabinet.
To prevent your blood pressure from dropping too much while you sleep, you should avoid taking an ACE inhibitor before bed. It is a good idea to track your blood pressure levels, then check with your healthcare provider to find the right time to take your medications.
Alcohol is also best avoided while taking an ACE inhibitor. Both lower blood pressure, so drinking may interact in unpredictable and unsafe ways with these medications.
ACE inhibitors are generally very well tolerated. Still, some side effects are possible.
For example, all blood pressure medications carry a risk of low blood pressure (hypotension). Symptoms of low blood pressure include:
If you experience low blood pressure, perhaps after standing up too quickly, try lying down for a few minutes. Eat a small,healthy snackand drink a glass of water.
If these symptoms last longer than 15 minutes, seek immediate medical help. In some cases, especially among older people, prolonged lightheadedness can be a sign of a heart attack or stroke. If your symptoms pass but recur often, check with your healthcare provider. You may need to reduce your medication dose.
High potassium levels, calledhyperkalemia, can also occur in rare cases. Be sure to tell your healthcare provider if you use a salt substitute that is high in potassium, such as Lo Salt.
The most common side effect of ACE inhibitors is a dry or hacking cough. This happens in between 4% and 35% of people who take ACE inhibitors.Many people who experience this side effect end up switching to a different medication.
If you develop a cough while taking an ACE inhibitor, talk to your healthcare provider. There are other medication options, such asangiotensinreceptor blockers, that do not cause coughing.
Angiotensin receptor blockers(ARBs) are similar to ACE inhibitors. People who are allergic to ACE inhibitors or who develop a cough while taking them can often successfully switch to ARBs.
Other side effects may include fatigue and headaches.Some people may also have skin allergic reactions, which can range from mild to severe. Rarely, ACE inhibitors can cause tissue swelling, called angioedema. This risk is higher in females and people of African and Asian descent.
Make sure to report any side effects to your healthcare provider, even if they seem minor. This is especially important whenever you start taking any new medication. This is because side effects are often avoidable, and may also be signs of a more serious problem.
Salt Intake and ACE InhibitorsToo much salt in your diet can decrease or cancel out the benefits of an ACE inhibitor. Restricting your salt or taking diuretic medications will enhance the effects of an ACE inhibitor. This is why it’s important to tell your healthcare provider if your salt consumption changes. These kinds of changes may require an adjustment of your ACE inhibitor dosage.
Salt Intake and ACE Inhibitors
Too much salt in your diet can decrease or cancel out the benefits of an ACE inhibitor. Restricting your salt or taking diuretic medications will enhance the effects of an ACE inhibitor. This is why it’s important to tell your healthcare provider if your salt consumption changes. These kinds of changes may require an adjustment of your ACE inhibitor dosage.
Warnings and Interactions
If you have diabetes, it’s important to tell your healthcare provider about any medication you are taking. This includes prescription and over-the-counter medications, as well as herbs and supplements.
If you’re taking an ACE inhibitor, check with your healthcare provider before you start taking any additional medications or supplements.
Summary
ACE inhibitors are medications used to treat high blood pressure. They are also used off-label to treat other conditions such as abnormal heart rhythms, rheumatoid arthritis, and migraines.
7 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Messerli FH, Bangalore S, Bavishi C, Rimoldi SF.Angiotensin-converting enzyme inhibitors in hypertension: to use or not to use?.J Am Coll Cardiol. 2018;71(13):1474-1482. doi:10.1016/j.jacc.2018.01.058Johns Hopkins Medicine.ACE inhibitors.U.S. Food and Drug Administration.Angiotensin-converting enzyme inhibitor (ACE inhibitor) drugs.U.S. National Library of Medicine.ACE inhibitors.American Heart Association.Low blood pressure - when blood pressure is too low.Yılmaz İ.Angiotensin-converting enzyme inhibitors induce cough.Turk Thorac J. 2019;20(1):36-42. doi:10.5152/TurkThoracJ.2018.18014Nia AM, Er F.Angioedema associated with the use of angiotensin-converting enzyme inhibitor.CMAJ. 2013;185(1):E80-. doi:10.1503/cmaj.111387Additional ReadingBakris GL.Treatment of hypertension in patients with diabetes mellitus. In: Nathan DM, White WB, eds.UpToDate. Waltham, Mass: UpToDate; 2021.Mann JFE.Choice of drug therapy in primary (essential) hypertension. In: Bakris GL, White WB, eds.UpToDate. Waltham, Mass: UpToDate; 2021.
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Messerli FH, Bangalore S, Bavishi C, Rimoldi SF.Angiotensin-converting enzyme inhibitors in hypertension: to use or not to use?.J Am Coll Cardiol. 2018;71(13):1474-1482. doi:10.1016/j.jacc.2018.01.058Johns Hopkins Medicine.ACE inhibitors.U.S. Food and Drug Administration.Angiotensin-converting enzyme inhibitor (ACE inhibitor) drugs.U.S. National Library of Medicine.ACE inhibitors.American Heart Association.Low blood pressure - when blood pressure is too low.Yılmaz İ.Angiotensin-converting enzyme inhibitors induce cough.Turk Thorac J. 2019;20(1):36-42. doi:10.5152/TurkThoracJ.2018.18014Nia AM, Er F.Angioedema associated with the use of angiotensin-converting enzyme inhibitor.CMAJ. 2013;185(1):E80-. doi:10.1503/cmaj.111387Additional ReadingBakris GL.Treatment of hypertension in patients with diabetes mellitus. In: Nathan DM, White WB, eds.UpToDate. Waltham, Mass: UpToDate; 2021.Mann JFE.Choice of drug therapy in primary (essential) hypertension. In: Bakris GL, White WB, eds.UpToDate. Waltham, Mass: UpToDate; 2021.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Messerli FH, Bangalore S, Bavishi C, Rimoldi SF.Angiotensin-converting enzyme inhibitors in hypertension: to use or not to use?.J Am Coll Cardiol. 2018;71(13):1474-1482. doi:10.1016/j.jacc.2018.01.058Johns Hopkins Medicine.ACE inhibitors.U.S. Food and Drug Administration.Angiotensin-converting enzyme inhibitor (ACE inhibitor) drugs.U.S. National Library of Medicine.ACE inhibitors.American Heart Association.Low blood pressure - when blood pressure is too low.Yılmaz İ.Angiotensin-converting enzyme inhibitors induce cough.Turk Thorac J. 2019;20(1):36-42. doi:10.5152/TurkThoracJ.2018.18014Nia AM, Er F.Angioedema associated with the use of angiotensin-converting enzyme inhibitor.CMAJ. 2013;185(1):E80-. doi:10.1503/cmaj.111387
Messerli FH, Bangalore S, Bavishi C, Rimoldi SF.Angiotensin-converting enzyme inhibitors in hypertension: to use or not to use?.J Am Coll Cardiol. 2018;71(13):1474-1482. doi:10.1016/j.jacc.2018.01.058
Johns Hopkins Medicine.ACE inhibitors.
U.S. Food and Drug Administration.Angiotensin-converting enzyme inhibitor (ACE inhibitor) drugs.
U.S. National Library of Medicine.ACE inhibitors.
American Heart Association.Low blood pressure - when blood pressure is too low.
Yılmaz İ.Angiotensin-converting enzyme inhibitors induce cough.Turk Thorac J. 2019;20(1):36-42. doi:10.5152/TurkThoracJ.2018.18014
Nia AM, Er F.Angioedema associated with the use of angiotensin-converting enzyme inhibitor.CMAJ. 2013;185(1):E80-. doi:10.1503/cmaj.111387
Bakris GL.Treatment of hypertension in patients with diabetes mellitus. In: Nathan DM, White WB, eds.UpToDate. Waltham, Mass: UpToDate; 2021.Mann JFE.Choice of drug therapy in primary (essential) hypertension. In: Bakris GL, White WB, eds.UpToDate. Waltham, Mass: UpToDate; 2021.
Bakris GL.Treatment of hypertension in patients with diabetes mellitus. In: Nathan DM, White WB, eds.UpToDate. Waltham, Mass: UpToDate; 2021.
Mann JFE.Choice of drug therapy in primary (essential) hypertension. In: Bakris GL, White WB, eds.UpToDate. Waltham, Mass: UpToDate; 2021.
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