Heart Failure: ACE Inhibitors

Angiotensin-converting enzyme (ACE) inhibitors are used to help treat heart failure. They relax blood vessels and lower blood pressure. This improves blood flow. Your heart is then able to pump more blood to the rest of your body without working harder.

Examples

  • Enalapril
  • Lisinopril
  • Quinapril
  • Ramipril

How do ACE inhibitors work?

When you have heart failure, your heart does not pump as well, so opening blood vessels and reducing blood pressure are important. This reduces how hard your heart needs to work. It may help keep blood from backing up in your heart and lungs.

ACE inhibitors block the action of a protein (enzyme) that causes blood vessels to narrow. As a result, blood vessels relax and widen. This lowers blood pressure and makes it easier for your heart to pump blood.

These medicines also help your body release water and salt (sodium), which also helps lower blood pressure.

Why are they used for heart failure?

ACE inhibitors may be used to help relieve heart failure symptoms, such as fluid buildup and swelling, and help you feel better. They can help some people live longer and stay out of the hospital.

You may need to take an ACE inhibitor if you have recently had a heart attack. This is true even if you do not have symptoms of heart failure.

Who should not take an ACE inhibitor?

Do NOT take an ACE inhibitor if:

  • You had a bad reaction when you took an ACE inhibitor before.
  • You have high potassium levels in your blood. An ACE inhibitor can raise potassium levels even more.
  • You have very low blood pressure, especially if your low blood pressure makes you feel weak or dizzy when you stand up.
  • You are pregnant.
  • You have a certain type of kidney problem. ACE inhibitors can make kidney function worse in people with renovascular disease. This is the kind of kidney disease caused by narrowed blood vessels.

How well do these medicines work?

ACE inhibitors have been shown to:

  • Slow how heart failure progresses.
  • Improve symptoms.
  • Help some people live longer.

Side effects

Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine. Common side effects of these medicines include:

  • A dry cough.
  • A rash or itching.
  • Symptoms like those from allergies.
  • An allergic reaction with swelling all over your body.
  • High potassium levels, especially in those who have kidney failure.
  • Low blood pressure, especially when you first start on ACE inhibitor medicine.

If you are taking other medicines, talk with your doctor before you take an ACE inhibitor. This includes medicines you can buy without a prescription, vitamins, herbs, and other supplements. ACE inhibitors may cause a bad reaction with nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs are medicines that reduce swelling, such as ibuprofen, naproxen, and aspirin. ACE inhibitors may also react with antacids, potassium pills, some diuretics, and lithium.

Call your doctor if you think you are having a problem with your medicine. Call 911 right away if you think you are having a serious reaction, such as trouble breathing.

What to think about

Usually, ACE inhibitors cause very few side effects. The most common side effect is an irritating, dry cough.

If you develop a cough from ACE inhibitors, you may be able to use another medicine such as an angiotensin receptor neprilysin inhibitor (ARNI) or anangiotensin II receptor blocker (ARB) instead. These medicines are less likely to cause a cough. Discuss this with your doctor.

You will likely have regular blood tests to monitor how the medicine is working in your body and to see if this medicine is causing problems.