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Angiotensin Converting Enzyme Inhibitors

Medically reviewed on May 11, 2018 by C. Fookes, BPharm

Other names: ACE inhibitors

What are ACE Inhibitors?

Angiotensin-converting enzyme inhibitors (ACE inhibitors) are a group of medicines that are mainly used to treat certain heart and kidney conditions; however, they may be used in the management of other conditions such as migraine and scleroderma.

They block the production of angiotensin II, a substance that narrows blood vessels and releases hormones such as aldosterone and norepinephrine, by inhibiting an enzyme called angiotensin converting enzyme. Angiotensin II, aldosterone, and norepinephrine all increase blood pressure and urine production by the kidneys. If levels of these three substances decrease in the body, this allows blood vessels to relax and dilate (widen), reducing both blood and kidney pressure. ACE inhibitors also increase the production of bradykinin, another substance that makes blood vessels dilate.

What are ACE inhibitors used for?

ACE inhibitors may be used for the treatment of the following conditions:

They may also be used for other conditions not listed here.

What are the differences between ACE inhibitors?

ACE inhibitors all work in the same way; by inhibiting the action of the angiotensin converting enzyme.

However, there are differences in their effectiveness at reducing blood pressure, their side effect profile, and their ability to prevent people from dying from a heart-related or other cause.

One review of 29 studies1 concluded that trandolapril was the most effective at reducing both systolic and diastolic blood pressure, while lisinopril was the least effective and is associated with the highest incidence of all-cause mortality. Ramipril was associated with the lowest risk of all-cause mortality. Another ACE inhibitor, enalapril, rated highly for heart pumping measures such as ejection fraction and stroke volume, but was associated with the highest risk of side effects such as cough, gastrointestinal discomfort, and a reduction in kidney function.

Generic name Examples of brand names
benazepril Lotensin
captopril Capoten
enalapril EpanedVasotec
fosinopril Monopril
lisinopril Prinivil, Zestril
moexipril Univasc
perindopril Aceon
quinapril Accupril
ramipril Altace
trandolapril Mavik

Are ACE inhibitors considered safe?

When taken at the recommended dosage, ACE inhibitors are considered safe. However, they have been associated with several serious adverse effects including:

  • Fetal harm and death: ACE inhibitors are not recommended for use during pregnancy and should be discontinued as soon as possible if a pregnancy inadvertently occurs. They can adversely affect a developing baby’s kidneys or cause miscarriage, particularly when taken during the second and third trimester.
  • Angioedema of the head, neck, or intestines: This is a skin reaction characterized by an acute and short-lived swelling of the lower layer of skin and tissue just under the skin or mucous membranes. When it involves the tongue or throat area this may result in severe breathing difficulties. Angioedema is more common in people who smoke and in African-Americans.
  • Potentially life-threatening allergic reactions (anaphylactoid reactions): These have most commonly occurred during densensitization therapy or associated with dialysis.

What are the side effects of ACE inhibitors?

Some of the more commonly reported side effects with ACE inhibitors include:

  • A dry persistent cough
  • Blurred vision
  • Dizziness
  • Dry mouth or loss of taste in the mouth
  • Fatigue
  • Gastrointestinal upset (such as constipation, diarrhea, or nausea)
  • Headache
  • Increased blood levels of potassium and creatinine
  • Low blood pressure or a drop in blood pressure, particularly when going from a lying to standing position (more common in people who are dehydrated)
  • Sweating.

ACE inhibitors may be less effective at lowering blood pressure in patients of African-American descent compared to those without this ethnicity.

For a complete list of side effects, please refer to the individual drug monographs.

ACE inhibitors can also interact with several other medications (including NSAIDs and lithium). Consult your prescribing doctor before taking any other medications including those brought over the counter.

1. Sun W, Zhang H, Guo J, et al. Comparison of the Efficacy and Safety of Different ACE Inhibitors in Patients With Chronic Heart Failure: A PRISMA-Compliant Network Meta-Analysis. Leischik. R, ed. Medicine. 2016;95(6):e2554. doi:10.1097/MD.0000000000002554.

List of Angiotensin Converting Enzyme Inhibitors:

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Drug Name Reviews Avg. Ratings
Monopril (Pro)
generic name: fosinopril
1 review
   
9.0
Capoten (Pro)
generic name: captopril
0 reviews
   
8.0
Univasc (Pro)
generic name: moexipril
2 reviews
   
8.0
Altace (Pro)
generic name: ramipril
9 reviews
   
7.9
Zestril (Pro)
generic name: lisinopril
11 reviews
   
7.8
Accupril (Pro)
generic name: quinapril
3 reviews
   
7.5
Mavik (Pro)
generic name: trandolapril
1 review
   
6.5
Vasotec (Pro)
generic name: enalapril
3 reviews
   
6.5
Lotensin (Pro)
generic name: benazepril
3 reviews
   
6.0
Prinivil (Pro)
generic name: lisinopril
10 reviews
   
5.8
Aceon (Pro)
generic name: perindopril
0 reviews
   
5.5
Qbrelis (Pro)
generic name: lisinopril
0 reviewsAdd rating

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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