Question 1

What are ACE inhibitors used to treat?

Accepted Answer

ACE inhibitors are used to treat hypertension, heart failure with reduced ejection fraction, chronic kidney disease (especially with diabetes), and to improve survival after a heart attack. They are also used to slow the progression of diabetic nephropathy. Common ACE inhibitors include lisinopril (Prinivil, Zestril) and ramipril (Altace), which are among the most prescribed drugs in the United States.

Question 2

How do ACE inhibitors lower blood pressure?

Accepted Answer

ACE inhibitors block angiotensin-converting enzyme (ACE), which normally converts angiotensin I to angiotensin II — a potent vasoconstrictor that also stimulates aldosterone release. By blocking this conversion, ACE inhibitors reduce vasoconstriction, decrease aldosterone-mediated sodium and water retention, and lower blood pressure. They also increase bradykinin levels, which contributes to vasodilation and, unfortunately, the characteristic dry cough.

Question 3

What is the ACE inhibitor cough and how common is it?

Accepted Answer

A persistent, dry, tickling cough is the most common reason patients stop ACE inhibitors, affecting approximately 10–15% of patients (and up to 30–40% in Asian populations). It is caused by bradykinin accumulation in the airways. The cough typically resolves within 1–4 weeks of stopping the medication. Patients who develop this cough are usually switched to an ARB (angiotensin receptor blocker), which does not affect bradykinin.

Question 4

Who should not take ACE inhibitors?

Accepted Answer

ACE inhibitors are contraindicated during pregnancy (risk of fetal kidney damage and death), in patients with a history of angioedema related to ACE inhibitor use, and in patients with bilateral renal artery stenosis. They must not be combined with ARBs or the direct renin inhibitor aliskiren in most patients due to increased risks without added benefit. Your healthcare provider will review your kidney function and potassium levels periodically while you are on an ACE inhibitor.

ACE Inhibitors

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