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ACE Inhibitors

January 25, 2013

ROCHESTER, Minn. — ACE inhibitors, short for angiotensin-converting enzyme inhibitors, are a common blood pressure treatment. The January issue of Mayo Clinic Health Letter covers how this drug works and its many uses.

ACE inhibitors make it possible for blood vessels to relax, lowering blood pressure. This occurs by preventing (inhibiting) an enzyme in the body from producing a substance (angiotensin II) that constricts blood vessels, forcing the heart to work harder. Angiotensin II also releases hormones that promote retention of sodium and water, which can contribute to high blood pressure.

About half of the people with mild to moderate high blood pressure manage the condition with ACE inhibitors alone. Or, a physician may recommend an ACE inhibitor with other types of blood pressure-lowering medications such as a diuretic or calcium channel blocker.

ACE inhibitors also are important in managing several other conditions.

Impaired left ventricle: ACE inhibitors are generally recommended at the first sign of impaired function of the heart's main pumping chamber, the left ventricle. ACE inhibitors can prevent or delay progression to congestive heart failure and reduce the incidence of heart attack or sudden death.

Heart attack: ACE inhibitors are generally a first treatment option after a heart attack. Depending on risk levels for future heart problems, a doctor may recommend long-term use.

Complications from high blood pressure: ACE inhibitors significantly reduce the chances of heart attack, stroke or early death related to high blood pressure.

Kidney health: High blood pressure can damage blood vessels throughout the body, including those in the kidneys. Clinical trials have found that ACE inhibitors delay the progression of diabetes-related kidney disease in people with type 1 diabetes. For type 2 diabetes, ACE inhibitors slow or decrease the loss of protein in urine.

A number of ACE inhibitors are on the market, including benazepril (Lotensin, others), captopril (Capoten, others), enalapril (Vasotec, others), fosinopril, lisinopril (Zestril, others), moexipril (Univasc, others), perindopril (Aceon, others), quinapril (Accupril, others), ramipril (Altace, others) and trandolapril (Mavik, others).

Like all medications, ACE inhibitors can cause side effects and are not appropriate for all people with high blood pressure. One in four people taking an ACE inhibitor develop a bothersome dry cough. People with significant kidney damage may not be suited to take ACE inhibitors because the medication can increase blood potassium to dangerous levels. A physician may recommend an alternative treatment for high blood pressure to avoid side effects or health complications.

Mayo Clinic Health Letter is an eight-page monthly newsletter of reliable, accurate and practical information on today's health and medical news. To subscribe, please call 800-333-9037 (toll-free), extension 9771, or visit Mayo Clinic Health Letter Online.

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