Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (sometimes called ARBs or A2RBs) are medicines that lower blood pressure. They are used to treat high blood pressure and heart failure and to protect your kidneys from damage if you have diabetes.

 

Why would I take ACE inhibitors and ARBs?
How do ACE inhibitors and ARBs work?
How to take ACE inhibitors and ARBs
Special care
Side-effects of ACE inhibitors and ARBs
Interactions of ACE inhibitors and ARBs with other medicines
Names of common ACE inhibitors and ARBs

 

Why would I take ACE inhibitors and ARBs?

Your doctor may recommend ACE inhibitors or ARBs if you have:

  • high blood pressure
  • heart failure
  • diabetes
  • had a heart attack

 

How do ACE inhibitors and ARBs work?

There are systems in your body that work together to keep your blood pressure at the level that is normal for you. This will be a pressure that is high enough to get enough oxygen and nutrients around your body, but not so high that your blood vessels or organs get damaged. ACE inhibitors and ARBs lower your blood pressure by affecting these systems.

Sensors on your kidney can detect when your blood pressure drops too low. When this happens, a hormone called angiotensin I is released into your blood. On its own, angiotensin I doesn't have much effect. But when angiotensin I meets angiotensin-converting enzyme (ACE) in the blood, it is converted into angiotensin II.

Angiotensin II can raise your blood pressure in two ways.

  • Firstly, it narrows your blood vessels – causing the pressure of the blood inside them to go up (a bit like squeezing a hose pipe).
  • Secondly, it triggers the release of another hormone called aldosterone. This tells your body to hold on to water, rather than getting rid of it in your urine. The extra water stays in your blood, increasing the volume of blood in your body. Your blood pressure increases because there is a larger amount of blood squeezed into the same space.

ACE inhibitors block the action of ACE so that angiotensin I is not converted to angiotensin II. So ACE inhibitors relax the walls of your blood vessels and lower your blood pressure.

ARBs interfere with the action of angiotensin II on blood vessels and also lower your blood pressure.

 

How to take ACE inhibitors and ARBs

ACE inhibitors and ARBs are only available on prescription. They usually come as tablets, which you will usually need to take once a day, as your doctor advises you.

Many people with high blood pressure or heart problems need to take more than one medicine. Your doctor may recommend that you take an ACE inhibitor in combination with other heart and blood pressure medicines, such as diuretics (water tablets).

Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

 

Special care

Your doctor may not prescribe ACE inhibitors or ARBs if you’re pregnant or breastfeeding. Both medicines may also be unsuitable if you have a problem with the arteries that supply your kidneys (renal artery stenosis). If you are African-Caribbean, ARBs may not work so for you, so your doctor may give you a different medicine.
 


Side-effects of ACE inhibitors and ARBs

This section does not include every possible side-effect of ACE inhibitors and ARBs.  Read the patient information leaflet that comes with your medicine for more information.

ACE inhibitors and ARBs can sometimes cause your blood pressure to fall, which may make you feel dizzy when you stand up. So, after taking a dose, get up slowly from lying or sitting down and stay next to your chair or bed until you’re sure that you’re not feeling dizzy. Dizziness can often be expected with some ACE inhibitors and ARBs, but your blood pressure will usually settle. If you continue to experience dizziness, see your GP for advice.

The most common side-effect of ACE inhibitors is a long-lasting dry cough. Other, less common, side-effects of ACE inhibitors are:

  • skin rash
  • hayfever-like symptoms (sneezing, blocked or runny nose, itchy eyes)
  • swelling of your sinuses (sinusitis)
  • sore throat
  • feeling sick or vomiting
  • indigestion
  • diarrhoea or constipation

In general, ARBs cause fewer side-effects than ACE inhibitors, and do not cause a dry cough. Side-effects include feeling dizzy.

It's important to weigh up the low risk of side-effects with the good chance that your health will benefit from taking these medicines.


Interactions of ACE inhibitors and ARBs with other medicines

Check with your doctor or pharmacist before you take any other medicines or herbal remedies at the same time as an ACE inhibitor or an ARB.

 

Names of common ACE inhibitors and ARBs

The main types of ACE inhibitors and ARBs are shown in the table.

All medicines have a generic name. Many medicines also have one or more brand name. Generic names are written in lower case, whereas brand names start with a capital letter.

Generic names

Brand names

ACE inhibitors

 

captopril

Capoten, Capto-co (with a diuretic), Capozide (in combination with a diuretic)
cilazapri

Vascace

enalapril maleat

Innovace, Innozide (with a diuretic)

fosinopril sodium

Staril

imidapril hydrochloride

Tanatril

lisinopril

Carace, Zestril, Carace Plus (with a diuretic), Lisicostad (with a diuretic), Zestoretic (with a diuretic)
 

moexipril hydrochloride

Perdix

perindopril erbumine

Coversyl Arginine, Coversyl Argenine Plus (with a diuretic)
quinapri

Accupro, Accuretic (with a diurectic)

ramipril

Tritace, Triapin (with a calcium-channel blocker)

trandolapril

Gopten, Tarka (with a calcium-channel blocker)

Angiotensin II receptor blockers (ARBs)  

candesartan cilexetil

Amias

eprosartan

Teveten

irbesartan

Aprovel, CoAprovel* (with a diuretic)

losartan potassium

Cozaar, Cozaar-Comp* (with a diuretic)

olmesartan medoxomil

Olmetec, Olmetec Plus* (with a diuretic)

telmisartan

Micardis, Micardis Plus* (with a diuretic)

valsartan

Diovan, Co-Diovan* (with a diuretic)

This information was published by Bupa’s health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: September 2009.
 

This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.

 

Why does my age affect whether I am prescribed ACE inhibitors and angiotensin II receptor blockers (ARBs)?
How do ACE inhibitors help people with diabetes?
Can I drink alcohol while taking ACE inhibitors or angiotensin II receptor blockers?

Why does my age affect whether I am prescribed ACE inhibitors and angiotensin II receptor blockers (ARBs)?

Answer

ACE inhibitors may not be so effective at reducing blood pressure in people over the age of 55. If you are aged 55 or over, your doctor will try to control your blood pressure with another type of medicine first.

Explanation

ACE inhibitors seem to be better at lowering blood pressure in younger people. This is thought to be because younger people with high blood pressure seem to have a higher level of a chemical called renin in their body. The body needs renin to make angiotensin I – the substance that is converted into angiotensin II in the body. It is angiotensin II that can raise your blood pressure.

Medicines such as ACE inhibitors that affect the renin-angiotensin system are therefore thought to have more effect in younger people than in older people who don't have so much renin.

ACE inhibitors are not as effective in African-Caribbean people for the same reason – because people in this ethnic group tend to have lower levels of renin than caucasian people.

If you have high blood pressure and are over 55 or are African-Caribbean, your GP will usually prescribe a diuretic or a calcium-channel blocker first, to try to control your blood pressure. If you don't respond to this medicine, he or she may then also prescribe an ACE inhibitor or an ARB.

 

How do ACE inhibitors help people with diabetes?

Answer

ACE inhibitors help to protect your kidneys if you have diabetes.

Explanation

If you have diabetes, you are at higher risk of getting kidney disease. This is because the high levels of glucose associated with diabetes can cause damage to the small blood vessels in your body, making your kidneys work less efficiently.

High blood pressure can cause further damage to your kidneys. So if you have diabetes, it is especially important to keep your blood pressure under control. ACE inhibitors are usually prescribed to control your blood pressure if you have diabetes, as they seem to offer better protection against kidney disease than other medicines for high blood pressure. Because of this, you will usually be prescribed an ACE inhibitor or an angiotensin II receptor blocker (ARB) if you have diabetes and tests have shown early signs of kidney disease, even if your blood pressure is normal.

As ACE inhibitors may help to prevent kidney disease whether or not you have high blood pressure, it has been suggested that they may have another action on the kidney, other than just lowering blood pressure. However, it is not clear at present what this may be, or whether their beneficial effects are just due to reducing blood pressure.

 

Can I drink alcohol while taking ACE inhibitors or angiotensin II receptor blockers?

Answer

You should try to keep your alcohol intake to a minimum if you are taking ACE inhibitors or ARBs.

Explanation

If you drink alcohol after taking an ACE inhibitor or ARB, it can exaggerate the medicine's blood pressure-lowering effect. Your blood pressure may become too low. This is called hypotension. This is quite a common side-effect in people taking ACE inhibitors and ARBs and drinking alcohol makes it even more likely to happen.

This means that even if you don't usually get any side-effects from your medicine, when you drink alcohol, you may feel dizzy, light-headed or faint. You should try to keep your alcohol intake to a minimum if you are taking ACE inhibitors or ARBs. Ask your GP or pharmacist for advice if you're not sure how much you should be drinking.
 

Further information

Sources

  • Joint Formulary Committee. British National Formulary. 57th ed. London: British Medical Association and the Royal Pharmaceutical Society of Great Britain, 2009: 100–108
  • Rang, H., M. Dale, Ritter J, et al. Pharmacology. 6th ed. London, Churchill Livingstone, 2007: 304
  • Joint Formulary Committee. British National Formulary. 57th ed. London: British Medical Association and the Royal Pharmaceutical Society of Great Britain, 2009: 101
  • Hypertension. Clinical Knowledge Summaries. www.cks.nhs.uk, accessed 15 June 2009
  • Hypertension: Management of hypertension in adults in primary care. National Institute for Health and Clinical Excellence (NICE), 2006. www.nice.org.uk
  • Simon C, Everitt H, and Kendrick T, Oxford handbook of general practice. 2nd ed. Oxford: Oxford University Press, 2005: 416
  • Type 2 Diabetes: the management of type 2 diabetes (update). National Institute for Health and Clinical Excellence (NICE), 2008. www.nice.org.uk
  • Curtiss FR. What evidence supports guidelines for use of ACE inhibitors and ARBs in diabetes? Journal of Managed Care Pharmacy, 2006. 12(8): 690–691

 

Related topics

Diabetes
Heart attack
Heart failure
High blood pressure

 

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