ACE Inhibitor Uses and Side Effects

Angiotensin-converting enzyme (ACE) inhibitors are oral medications that lower blood pressure. They are used to treat a variety of heart-related conditions including high blood pressure, coronary artery disease, and heart failure. They may help to lower your risk of stroke.

ACE inhibitors also are used to help control the progression of kidney disease and help manage and prevent complications from diabetes, such as diabetic nephropathy.

Off-label uses outside of the drug's formal Food and Drug Administration (FDA) approval can include migraines and other health issues. Researchers continue to investigate ACE inhibitor use in treating liver disease, uterine fibroids, and more.

How ACE Inhibitors Are Used

ACE inhibitors were approved for treating hypertension in 1981. Over time, ACE inhibitor use was expanded by the FDA to include treatment for cardiovascular disease and heart-related conditions, including:

• Reducing the risk of stroke
• Treating diabetic nephropathy, a type of kidney disease

ACE inhibitors are sometimes used off-label. This means a healthcare provider may prescribe them to treat a health problem other than the one approved by the FDA. Research continues into their effects on the immune system and potential therapeutic role in treating:

• Cancer
• Autoimmune conditions, like lupus, multiple sclerosis, and rheumatoid arthritis
• Alzheimer's disease
• Myocarditis, an inflammation of heart tissue
• Infection
• Liver disease
• Uterine fibroids
  

With diabetes, ACE inhibitors don’t directly lower blood sugar, but they can contribute to blood sugar control and lower the risk of heart and kidney complications with diabetes.

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 help prevent heart failure by reducing blood pressure and fluid retention.

These ACE inhibitor medications include:

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

Precautions and Contraindications

You should not take ACE inhibitors if:

• You have very low blood pressure (hypotension).
• You have renal artery stenosis, a condition that causes narrowing of the arteries that supply the kidneys with blood.
• You have had an allergy or, in some cases, a cough related to ACE inhibitor use.
  

If you have significant kidney 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.

Side Effects

ACE inhibitors are generally very well tolerated. Still, some side effects are possible. These side effects include:

• Sweating
• Lightheadedness
• Dizziness, numbness, and fainting
• Headache
• Fatigue
• Digestive symptoms (nausea, loss of appetite, diarrhea)
• Fever
• Skin rashes or blisters
• Joint pain

If you experience low blood pressure, perhaps after standing up too quickly, try lying down for a few minutes. Rarely, ACE inhibitors also cause:

•  Low blood sugar (hypoglycemia): This can happen in people with diabetes who have blood sugar levels that are otherwise well controlled by diet and other antidiabetic medications.
• High potassium levels, called hyperkalemia: Be sure to tell your healthcare provider if you use a salt substitute that is high in potassium.
• 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 like an angiotensin receptor blocker (ARB).

Tissue swelling, called angioedema, can occur in the face and lips and may be a sign of an allergic reaction. Seek medical attention if this symptom occurs.

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.

Dosage

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. Be sure to:

• Take your medicines at the same time each day.
• Tell your provider what other medicines or supplements you are taking.
• Avoid alcohol, which can add to the effect of lower blood pressure.

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.

Summary

ACE inhibitors are medications used to treat high blood pressure. They are also used off-label to treat other conditions such as rheumatoid arthritis. Research continues into potential benefits in other conditions, including cancer and liver disease.

ACE inhibitors can cause side effects like low blood pressure or a dry, hacking cough. They are generally safe but check with your health provider about their use with other medications or underlying health conditions, like diabetes and kidney disease.