Angiotensin-converting enzyme (ACE) inhibitors for heart attack and unstable angina

Examples

Generic Name Brand Name
benazepril Lotensin
captopril Capoten
enalapril maleate Vasotec
fosinopril Monopril
lisinopril Prinivil, Zestoretic, Zestril
quinapril Accupril
ramipril Altace
trandolapril Mavik

How It Works

Angiotensin-converting enzyme (ACE) inhibitors interfere with the formation of a hormone (angiotensin II) that can narrow (constrict) blood vessels. ACE inhibitors help lower blood pressure and reduce the workload on the heart, which lowers the chance of a heart attack.

Why It Is Used

ACE inhibitors are recommended immediately after a heart attack to reduce complications. These drugs frequently are used to treat high blood pressure and heart failure.

How Well It Works

ACE inhibitors often are used for people who have recently had a heart attack and who have heart failure or decreased function of the left ventricle (lower left heart chamber). Use of ACE inhibitors following a heart attack can help prevent heart failure and may improve survival.

If used within 24 hours of the start of heart attack symptoms, ACE inhibitors reduce the risk of future death associated with a heart attack.1

Side Effects

Side effects may include:

  • Cough. A cough is one of the most common side effects of ACE inhibitors. Most people find the cough to be a minor problem that they can tolerate in exchange for the benefits of this medicine. If coughing is a severe problem, other medicines can be tried.
  • Low blood pressure. Another side effect of ACE inhibitors may be low blood pressure, which may cause symptoms of dizziness, weakness, or fainting. People with low to normal blood pressure generally will be started on a low dose of medicine and need their blood pressure monitored regularly.
  • Swelling. In rare cases, swelling in the face, neck, lips, throat, hands, feet, or genitals may occur with ACE inhibitors. If swelling affects the face or throat, it can interfere with breathing. If this occurs, notify your doctor immediately.
  • High potassium levels. A high potassium level can disrupt the normal electrical impulses in the heart. This can lead to irregular heartbeats (arrhythmias). Potassium levels are monitored with blood tests.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

If you are pregnant or may become pregnant, do not take ACE inhibitors.

A cough is one of the most common side effects of ACE inhibitors. Most people find the cough to be a minor problem that they can live with in exchange for the benefits of this medicine. If you take an ACE inhibitor and have a problem with coughing, then you might take an angiotensin II receptor blocker (ARB) instead. ARBs are less likely to cause a cough.

ACE inhibitors may interact with other medicines such as nonsteroidal anti-inflammatory drugs (NSAIDs), antacids, potassium supplements, certain diuretics, and lithium. If you are taking one of these medicines, talk with your doctor before you take an ACE inhibitor.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

References

Citations

  1. Danchin N, Durand E (2006). Acute myocardial infarction, search date August 2004. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.

Last Updated: May 5, 2009

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