ACE-Inhibitors

Angiotensin Converting Enzyme (ACE) Inhibitors are used to manage hypertension (high blood pressure). These medications lower blood pressure by preventing the formation of angiotensin II, a hormone in the body that causes blood vessels to constrict (close). This constriction of the blood vessels is due to angiotensin II, a hormone that is an important component of hypertension. Blocking the hormone causes the blood vessels to relax or dilate (open), and thus helps to reduce blood pressure.

Drugs in this Class
Captopril (Capoten)
Fosinopril Tablets (Fosinopril Sodium Tablets, Monopril Tablets)
Ramipril Capsules (Altace Capsules)
Trandolapril (Mavik)
Benazepril (Lotensin)
Enalapril Tablets (Enalapril Maleate Tablets, Vasotec Tablets)
Perindopril Tablets (Aceon Tablets, Perindopril Erbumine Tablets)
Lisinopril Tablets (Prinivil Tablets, Zestril Tablets)
Moexipril Tablets (Moexipril Hydrochloride Tablets, Univasc Tablets)
Quinapril (Accupril)
Enalaprilat Solution for Injection ()

Summarizing the Evidence

  • All ACE-Inhibitors have been shown to be effective in lowering blood pressure. Many scientific studies comparing the drugs in this class have been published and no clinically relevant differences in effectiveness have been demonstrated between the drugs. Because the ACE-Inhibitors all work in the same manner, it is generally thought that each drug in this class is effective in treating blood pressure.

  • The seventh report of the Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7) recommends ACE-Inhibitors should be considered for the treatment of hypertension when an individual also has diabetes, heart failure, kidney dysfunction, or if an individual has had a heart attack. However, the drug selected to lower blood pressure often depends on numerous factors including other diseases or conditions you may have, other medications you may be taking, and medication costs. Your doctor is the best person to decide what medicine is best to lower your blood pressure.

  • Common side effects of the ACE-Inhibitors include nausea, vomiting, diarrhea, cough, low blood pressure, headache and dizziness. A dry, non-productive cough is the most frequently reported side effect with the ACE-Inhibitors. While it appears as though the incidence of cough is similar among all ACE-Inhibitors, some patients who experience a cough while taking one ACE-Inhibitor will not necessarily experience a cough when they switch to another ACE-Inhibitor. A few studies have demonstrated that patients taking fosinopril may have the least incidence of cough. If your cough becomes bothersome, you should contact your doctor.

Dosing and Administration

  • The ACE-Inhibitors can be dosed once or twice daily, except for captopril, which can be taken up to three times daily. Captopril and moexipril need to be taken on an empty stomach, because food can decrease the absorption of these drugs.

Generic Availability

  • Currently, benazepril, captopril, enalapril, fosinopril, quinapril, moexipril, trandolapril, and lisinopril are available generically and therefore, may be less expensive than the other ACE-Inhibitors.

Drug Interactions

Some interactions between medications can be more severe than others. The best way for you to avoid harmful interactions is to tell your doctor and/or pharmacist what medications you are currently taking, including any over-the-counter products, vitamins, and herbals. For specific information on how the drugs interact and the severity of the interaction, please use our Drug Interactions Checker.

Side Effects

To view specific side effect information, please use our Side Effect Checker.

Additional Information

  1. Carter BL, Saseen JJ. Hypertension. In: Dipiro JT, Talbert RL, Yee GC, et al., eds. Pharmacotherapy: a pathophysiologic approach. 5th ed. New York:McGraw-Hill; 2002:157-183.
  2. Capoten [package insert]. Princeton, NJ: Brisol-Myers Squibb; June 2003.
  3. Vasotec [package insert]. Morrisville, NC. Bioavail; August 2002.
  4. Prinivil [package insert]. Whitehouse Station, NJ: Merck & Co.; August 2006.
  5. Zestril [package insert]. Wilmington, DE: AstraZeneca; December 2005.
  6. Lotensin [package insert]. East Hanover, NJ: Novartis; June 2007.
  7. Monopril [package insert]. Princeton, NJ: Bristol-Myers Squibb; July 2003.
  8. Accupril [package insert]. Morris Plains, NJ: Parke-Davis; February 2003.
  9. Altace [package insert]. Bristol, TN: Monarch Pharmaceuticals; September 2005.
  10. Univasc [package insert]. Milwaukee, WI: Schwarz Pharma; May 2003.
  11. Mavik [package insert]. North Chicago, IL: Abbott Laboratories; July 2003.
  12. Aceon [package insert]. Marietta, GA: Solvay Pharmaceuticals; May 2005.
  13. Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. JAMA. 2003; 285:2560-2572.
  14. Bosch J, Yusuf S, Pogue J, et al. Use of ramipril in preventing stroke: double blind randomised trial. BMJ. 2002 Mar 23;324(7339):699.
  15. Furberg C, Pitt B. Are all angiotensin-converting enzyme inhibitors interchangeable. J Am Coll Cardiol. 2000;37(5):1456-1460.
  16. Verne-Gibboney C. Oral angiotensin-converting enzyme inhibitors. Am J Health-Syst Pharm. 1997;54(1):2689-2703.
  17. Leonetti G, Cuspidi C. Choosing the right ACE inhibitor: a guide to selection. Drugs. 1995;49(4):516-535.
  18. White CM. Pharmacologic, pharmacokinetic, and therapeutic differences among ACE inhibitors. Pharmacotherapy. 1998;18:588-599.
  19. Chobanian AV, Bakris GL, Black HR, et al, and the National High Blood Pressure Education Program Coordinating Committee. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The JNC 7 Report. JAMA. 2003;289:2560-2571.
  20. American Diabetes Association. Diabetic nephropathy [position statement]. Diabetes Care. 2001;24:598-601.
  21. The African American Study of Kidney Sisease and Hypertension investigators. Effect of ramipril vs amlodipine on renal outcomes in hypertensive nephrosclerosis. JAMA. 2001;285(21):2719-2728.
  22. Brown NJ, Vaughan DE. Angiotensin-converting enzyme inhibitors. Circulation. 1998;97:1411-1420.
  23. David D. The Fosinopril Cough Multicentre Study Group. Multicentre, double-blind, randomized trial comparing fosinopril to enalapril in patients with previous angiotensin converting enzyme cough. J Hypertens. 1994;12(Suppl 3):S92.
  24. Knapp I, Frank G, McLain R, Reiger M, Posvar E, Singer R. The safety and tolerability of quinapril. J Cardiovasc Pharmacol. 1990;15(Suppl 2):S47-S55.
  25. Howes L. Critical assessment of ACE Inhibitors (Part 2). Austr Fam Phys. 1995;24(3):639-643.
  26. Lieberman E. Pediatric hypertension: clinical perspective. Mayo Clin Proc. 1994;69:1098-1107.
  27. Sinaiki AR. Hypertension in Children. NEJM. 1996;335:1968-1973.
  28. Tobe S, Kawecka-Jaszcz K, Zannad F, et al. Amlodipine added to quinapril vs quinapril alone for the treatment of hypertension in diabetes: the Amlodipine in Diabetes (ANDI) trial. Journal of Clinical Hypertension (Greenwich). 2007 Feb;9(2):120-127.
  29. Chrysant SG, Sugimoto DH, Lefkowitz M, et al. The effects of high-dose amlodipine/benazepril combination therapies on blood pressure reduction in patients not adequately controlled with amlodipine monotherapy. Blood Pressure (Supplement). 2007 March;1:10-17.

Last Updated: April 2008

Note: The above information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist, or other healthcare professional. It should not be construed to indicate that the use of the product is safe, appropriate, or effective for you. Consult your healthcare professional before taking any medication.

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