In hypertension, ACE-I are a first line treatment in patients below 55 years of age or in combination with other antihypertensives. ACE-I relax the blood vessels and lower the blood pressure by blocking the activity of angiotensin-II converting enzyme. In this way, ACE inhibitors decrease workload on the heart and help improve blood flow to body organs. ACE-I are particularly advantageous in treatment of hypertension in patient with diabetes, coronary artery disease and renal disease. ACE inhibitors are also indicated in treatment of heart failure, particularly in combination with beta blockers, aldosterone antagonists and diuretics.
Ramipril, lisinopril, perindopril, trandolapril and enalapril are the most commonly used ACE inhibitors in the UK.
Patients on ACE inhibitors you need to monitor to monitor their blood pressure regularly. Also, GPs will normally check their kidney function by taking a blood sample about 7-10 days after starting the treatment and following each subsequent adjustment in dose. ACE inhibitors may rarely exacerbate kidney problems but are actually beneficial in patients with mild kidney disease. As with any other medication, ACE inhibitors should not be stopped without medical advice. Sudden withdrawal of ACE inhibitors may lead to dangerous increase in blood pressure.
Dry cough is the most common side effect of ACE inhibitors and in some people may necessitate change to angiotensin receptor blockers (ARBs) which have a very similar mode of action but without this particular side effect. Some people may experience dizziness or even fainting due to excessive drop in blood pressure (hypotension), in which case ACE inhibitor should be taken in the evening before going to bed.