Angiotensin-converting enzyme (ACE) inhibitors widen blood vessels and decrease the workload of the heart. They treat high blood pressure and can also help protect the heart and kidneys.
Patients with heart failure or an enlarged left ventricle, previous heart attack, diabetes, or kidney disease are considered particularly good candidates for ACE inhibitors as part of treatment for high blood pressure.
Aspirin is recommended for reducing the risk of cardiac problems in patients with heart disease, and can safely be used in combination with ACE inhibitors, particularly at lower dosages of aspirin (75 - 81 mg).
Brands. ACE inhibitors include captopril (Capoten), enalapril (Vasotec), quinapril (Accupril), benazepril (Lotensin), ramipril (Altace), perindopril (Aceon), and lisinopril (Prinivil, Zestril).
Common Side Effects of ACE Inhibitors.
- Low blood pressure is the main side effect of ACE inhibitors. This can be severe in some patients, especially at the start of therapy.
- Irritating cough is a common side effect, which some people find intolerable.
- ACE inhibitors can harm a developing fetus and should not be used during pregnancy. Women who become pregnant should change from ACE inhibitors to another type of blood pressure drug as soon as possible. Women of child-bearing age who are considering becoming pregnant should also discuss other medications with their doctors.
- ACE inhibitors can increase potassium levels, particularly in patients with kidney disease.
Uncommon Side Effects of ACE Inhibitors.
- ACE inhibitors protect against kidney disease, but they may also increase potassium retention by the kidneys. If potassium levels become extremely high, they can cause the heart to stop beating (cardiac arrest). This side effect is uncommon, except in patients with significant kidney disease. Because of this risk, ACE inhibitors are not usually used in combination with potassium-sparing diuretics or potassium supplements.
- A rare but severe side effect is granulocytopenia, an extreme reduction in infection-fighting white blood cells.
- In very rare cases, patients suffer a sudden and severe allergic reaction, called angioedema that causes swelling in the eyes and mouth and may close off the throat.
Patients who have difficulty tolerating ACE inhibitor side effects are usually switched to an angiotensin-receptor blocker (ARB).
Review Date: 04/06/2010
Reviewed By: Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.