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ACE Inhibitors: Beyond Blood Pressure Treatment

Angiotensin-converting enzyme (ACE) inhibitors often treat high blood pressure and other heart-related conditions. They are a commonly prescribed class of medicine that has been used for several decades with proven clinical benefits. They work by inhibiting the activity of an angiotensin-converting enzyme, which regulates blood pressure and fluid balance in the body. In this article, we will explore what this class of medication is and how they can help manage cardiovascular-related conditions.


What are the Benefits?

ACE inhibitors have several benefits for the heart, including:

Reducing Blood Pressure: By relaxing blood vessels and reducing the amount of angiotensin II in the bloodstream, ACE inhibitors can help lower blood pressure. This can help reduce the risk of heart attack, stroke, and other complications associated with high blood pressure.

Improving Heart Function: ACE inhibitors can also improve heart function in people with heart failure. By reducing the workload on the heart, these medications can help improve symptoms like shortness of breath, fatigue, and swelling in the legs.

Protecting the Heart: ACE inhibitors may also protect the heart by reducing the risk of heart attack and other cardiac events. Some studies have suggested that these medications may also help prevent the progression of atherosclerosis, a condition that can lead to heart disease.

Stroke Management: Managing blood pressure and preventing further cardiovascular complications is crucial after a stroke. ACE inhibitors can be a valuable component of post-stroke care, helping control blood pressure, stabilize heart function, and protect kidney health. This is especially relevant given the increased cardiovascular risks associated with stroke.

What Conditions are Treated with ACE Inhibitors?

ACE inhibitors are commonly used to treat the following conditions:

  1. High Blood Pressure (Hypertension): ACE inhibitors are commonly prescribed as a first-line treatment for hypertension. They work by relaxing blood vessels, which helps lower blood pressure. ACE inhibitors help mitigate the risks associated with high blood pressure, such as heart attacks and strokes, by reducing the strain on the heart.
  2. Heart Failure: Heart failure is when the heart’s ability to pump blood efficiently is compromised. ACE inhibitors are frequently used in the management of heart failure. They offer multiple benefits, including improving symptoms like shortness of breath and fatigue, reducing the risk of hospitalization, and ultimately enhancing survival rates in individuals with this condition. These medications help the heart pump more effectively and reduce its workload.
  3. Coronary Artery Disease: ACE inhibitors also find application in managing coronary artery disease, especially in individuals who have a history of heart attacks or are at high risk for one. These medications can help dilate the coronary arteries, increasing blood flow to the heart muscle. This improved blood flow can reduce the risk of angina (chest pain) and further heart complications.
  4. Diabetic Nephropathy: Diabetes can have adverse effects on the kidneys, leading to a condition known as diabetic nephropathy, where kidney function deteriorates over time. ACE inhibitors are sometimes prescribed to individuals with diabetes who have impaired kidney function or to help prevent the onset of this. These medications effectively slow the progression of kidney disease and reduce the risk of kidney failure by reducing pressure in the kidney’s filtering units.


How are ACE Inhibitors Taken?

ACE inhibitors are available in several forms, including tablets, capsules, and liquid formulations. They are typically taken once or twice daily, with or without food. Taking these medications as your doctor directs to get the most benefit and avoid any potential side effects is important. Below is a table listing commonly used ACE inhibitors around the world, their generic names, commonly known trade names, and the usual tablet strengths:


What are the Side Effects of ACE Inhibitors?

Like all medications, ACE inhibitors can cause side effects. Some common side effects include:

Dry Cough: ACE inhibitors can cause a persistent dry cough in some people. This side effect may be more common in women. Learn more about cough as a side effect with our feature article here.

Dizziness and Fatigue: ACE inhibitors can cause dizziness and fatigue, especially when starting the medication or increasing the dose. 

Low Blood Pressure: In some cases, ACE inhibitors can cause a sudden drop in blood pressure, especially in dehydrated people or those with kidney problems.

High potassium levels (Hyperkalemia): ACE inhibitors can sometimes cause high levels of potassium in the blood, especially in people with kidney disease or those taking certain supplements or diuretic medicines.

ACE inhibitors are a medication commonly used to treat high blood pressure, heart failure, and other conditions related to heart health. They work by inhibiting the enzyme ACE, which helps regulate blood pressure and improve heart function. Although they may cause side effects in some people, ACE inhibitors are generally well-tolerated and can be an effective treatment option for many people with heart health concerns. If you have questions or concerns about ACE inhibitors, talk to your doctor or healthcare provider.

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other anti-anginals

When first-line therapies for angina, such as beta blockers, calcium channel blockers, and nitrates, prove inadequate or are not well-tolerated, second-line therapies may be considered.
Perhexiline is a unique medication that enhances the heart's ability to utilize fatty acids for energy, reducing its reliance on oxygen and lowering oxygen demand. This action helps improve blood flow and alleviates chest pain in some patients with refractory angina.
Nicorandil is another second-line option with a dual mechanism of action. It opens potassium channels in smooth muscle cells, causing vasodilation and enhancing coronary blood flow. Additionally, nicorandil also stimulates nitric oxide release, further dilating blood vessels and reducing heart workload.
Trimetazidine is an anti-ischemic agent that improves cardiac efficiency by enhancing glucose metabolism and shifting the heart's energy production to a more oxygen-efficient process. As second-line therapies, these medications offer alternative approaches for managing angina in individuals who do not respond adequately to first-line treatments or those experiencing side effects from other medications.

lipid lowering therapies

Lipid-lowering therapies play a critical role in managing coronary artery disease (CAD), a condition characterized by the narrowing of blood vessels that supply the heart. Among the most commonly discussed and debated classes of medications are statins, which effectively reduce cholesterol levels and are widely prescribed to lower the risk of cardiovascular events. Alongside statins, other medications like ezetimibe, fibrates, and niacin are also utilized to target specific aspects of lipid metabolism, such as cholesterol absorption, triglyceride levels, and raising high-density lipoprotein (HDL) cholesterol. Additionally, the introduction of medications that inhibit PCSK9, an enzyme involved in cholesterol metabolism, has provided a promising new approach to further lower LDL cholesterol levels. These PCSK9 inhibitors, such as Repatha (evolocumab), have shown significant efficacy in reducing LDL cholesterol levels in patients with CAD, especially for those who may not respond well to traditional therapies.


Nitrates are widely used to treat angina and provide quick relief for chest pain. Commonly available in the form of sublingual sprays or tablets, patches, and long-acting tablets, nitrates work by dilating blood vessels, allowing for increased blood flow and reduced resistance. This dilation eases the heart's workload, leading to a decreased demand for oxygen and prompt alleviation of angina symptoms. Sublingual nitrates act rapidly and are often used to provide immediate relief during angina attacks, while patches and long-acting tablets are employed for preventive purposes. However, nitrates may cause side effects such as headaches, dizziness, and flushing, which usually subside over time.

calcium channel blockers

Calcium channel blockers, including amlodipine, felodipine, cardizem (diltiazem), and verapamil, are commonly prescribed for the treatment of angina. These medications work by inhibiting the influx of calcium into the muscle cells of the heart and blood vessels, leading to their relaxation. As a result, blood vessels widen, promoting improved blood flow and reduced blood pressure. In the context of angina, this relaxation decreases the heart's workload, lowering the demand for oxygen and alleviating chest pain. Calcium channel blockers offer a valuable treatment option for individuals with angina, but it is essential to be aware of potential side effects, which may include headaches, dizziness, flushing, and ankle swelling.

Beta blockers

Beta blockers, such as metoprolol, propranolol, atenolol, carvedilol, and bisoprolol, play a crucial role in treating angina. By blocking certain receptors in the heart, they effectively reduce heart rate and the force of contraction, thereby easing the heart's workload. This mechanism of action leads to a decreased demand for oxygen, making beta blockers highly effective in relieving chest pain associated with angina. As with any medication, it's important to consider potential side effects, including tiredness, worsened asthma, erectile dysfunction in some males, and more vivid dreams during sleep. Consult your healthcare provider to determine the suitability of beta blockers for managing your angina and overall heart health.

Anti-platelet Medications

Anti-platelet medications play a crucial role in preventing blood clot formation, reducing the risk of serious cardiovascular events such as heart attacks and strokes. Among the widely used anti-platelet drugs are aspirin, clopidogrel, and ticagrelor.

Aspirin: This well-known medication inhibits platelet activation, making it less likely for platelets to stick together and form clots. Aspirin is commonly used for primary and secondary prevention of heart attacks and strokes.

Clopidogrel: As a potent anti-platelet agent, clopidogrel works by blocking specific receptors on platelets, preventing them from aggregating. It is often prescribed to patients with acute coronary syndrome, those undergoing stent procedures, and for some cases of peripheral arterial disease.

Ticagrelor: Ticagrelor is another effective anti-platelet drug that works by inhibiting platelet activation. It is used in acute coronary syndrome, often given alongside aspirin to reduce the risk of heart-related events.