Angiotensin-Converting Enzyme (ACE) Inhibitors

Reviewed by: HU Medical Review Board | Last reviewed: June 2023

Angiotensin-converting enzyme (ACE) inhibitors are a type of drug prescribed for people with systolic heart failure (HF) caused by left ventricular dysfunction. ACE inhibitors can be used by people with systolic HF either with or without symptoms. They can help reverse heart damage.1

Treatment goals of ACE inhibitors include:1

  • Improved heart function or delayed progression of heart failure
  • Symptom relief
  • Decreased risk of hospitalization for heart failure
  • Decreased risk of death from heart failure

Some ACE inhibitors are combined with a diuretic (water pill) into one pill.2

How do ACE inhibitors work?

ACE inhibitors are a type of medicine known as vasodilators. They work by blocking angiotensin II, a hormone in the body that makes the muscles around your blood vessels tighten (vasoconstriction). This can raise your blood pressure.1-4

By blocking angiotensin II, ACE inhibitors widen blood vessels to:1-4

  • Lower blood pressure
  • Improve blood flow
  • Reduce how hard your heart has to work to pump blood

Examples

Commonly prescribed ACE inhibitors include:1-4

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

ACE inhibitors combined with hydrochlorothiazide (HCTZ) diuretics include:5

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

What are the possible side effects?

Side effects can vary depending on the specific drug you are taking. The most common side effects of ACE inhibitors include:5

  • Dry cough
  • High potassium levels (hyperkalemia)
  • Fatigue
  • Dizziness
  • Headaches
  • Loss of taste

ACE inhibitor drugs have boxed warnings, the strictest warning from the US Food and Drug Administration (FDA). They have this warning because they can cause harm to an unborn baby during pregnancy. ACE inhibitors should not be used during the second and third trimester of pregnancy. They can cause low levels of fluid that surrounds the baby (amniotic fluid). Low levels of this fluid can cause problems for the baby, including poor growth and birth defects.6

These are not all the possible side effects of ACE inhibitors. Talk to your doctor about what to expect when taking an ACE inhibitor. You also should call your doctor if you have any changes that concern you when taking an ACE inhibitor.

Other things to know

Before taking an ACE inhibitor, tell your doctor if you:4,5

  • Have high potassium levels
  • Have low blood pressure
  • Have kidney problems
  • Are pregnant or planning to become pregnant

Nonsteroidal anti-inflammatory drugs (NSAIDs) decrease the effectiveness of ACE inhibitors. If you regularly take NSAIDs, talk to your doctor before starting an ACE inhibitor.5

Before beginning treatment for heart failure, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.

By providing your email address, you are agreeing to our privacy policy.