Heart Failure: Treatment with ACE Inhibitors

ACE inhibitors are a vasodilator; that means they dilate (or widen) the blood vessels to improve blood flow, which helps to decrease the amount of work the heart has to do. They also block some of the harmful substances in the blood (angiotensin) that are produced as a result of heart failure. Angiotensin is one of the most powerful vasoconstrictors (they narrow the blood vessels) in the body.

ACE inhibitors are critical in the treatment of heart failure when systolic dysfunction is present and may also be prescribed for the treatment of diastolic dysfunction.

They are also used to control high blood pressure, prevent kidney damage in diabetics and prevent ongoing heart damage after a heart attack. ACE inhibitors include:

• Capoten
• Vasotec
• Prinivil
• Zestril
• Lotensin
• Monopril
• Altace
• Accupril
• Aceon
• Mavik
• Univasc

How Do I Take This Medicine?

These medications are usually taken on an empty stomach one hour before meals. Follow the label directions on how often to take your medication. The number of doses you take each day, the time allowed between doses and how long you need to take the medication will depend on the type of ACE inhibitor prescribed, as well as your condition.

What Side Effects Could I Experience?

• Red, itchy skin rash: Contact your doctor; do not treat the rash yourself.
• Dizziness, lightheadedness, or faintness upon rising: This side effect may be strongest after the first dose, especially if you have been taking a diuretic (water pill). Get up more slowly. Contact your doctor if these symptoms persist or are severe.
• Salty or metallic taste and a decreased ability to taste: This effect usually goes away as you continue taking the medication.
• Cough: If this symptom persists or is severe, contact your doctor. Otherwise, ask your doctor what type of cough medicine you may use to control the cough.
• Sore throat; fever; mouth sores; unusual bruising; fast or irregular heart beat; chest pain; swelling of feet, ankles, lower legs: Contact your doctor.
• Swelling of your neck, face and tongue: Contact your doctor right away.
• Confusion; irregular heartbeat; nervousness; numbness or tingling in hands, feet or lips; shortness of breath or difficulty breathing; weakness or heaviness in legs: These are signs of too much potassium in the body. Contact your doctor right away.

If you become sick with severe vomiting or diarrhea, you may become dehydrated, which can lead to low blood pressure. Contact your doctor. Also contact your doctor if you have any other symptoms that cause concern.

Should I Avoid Certain Food or Medicine While Taking ACE Inhibitors?

Yes. These include:

• Do not use salt substitutes: they contain potassium and ACE inhibitor medications cause the body to retain potassium.
• Over-the-counter nonsteroidal anti-inflammatory medications or NSAIDs (like Motrin, Aleve, ibuprofen or naproxen) and aspirin may cause the body to retain (keep) sodium and water, and decrease the effect of an ACE inhibitor. Check with your doctor before taking any anti-inflammatory medications.

It is important that your doctor is aware of all the medications you are taking, as some may potentially interact with ACE inhibitors. Talk to your doctor before taking any new medication, including over-the-counter drugs, herbs and supplements.