ACE inhibitors combined with diuretic
|enalapril and hydrochlorothiazide
|lisinopril and hydrochlorothiazide
How It Works
Angiotensin-converting enzyme (ACE)
inhibitors block the activity of an enzyme that causes blood vessels to
constrict (narrow). As a result, blood vessels relax and widen (dilate), making
it easier for blood to flow through the vessels, which reduces blood
Preventing blood vessels from narrowing helps improve
blood flow, reduces the backup of blood in the heart and lungs, and decreases
the pressure that the heart's left chamber (ventricle) must pump
These medicines also increase the release of water and
salt (sodium) to the urine, which lowers blood pressure. ACE inhibitors (and
angiotensin II receptor blockers, also called ARBs) also act directly on the
hormones that regulate sodium and water balance in the body.
Why It Is Used
systolic heart failure, which is caused by left ventricular dysfunction,
will probably be given an ACE inhibitor if possible.
ACE inhibitors may be used for people with symptoms of heart failure and for people without symptoms.
People who should not take ACE inhibitors include:
- People who have had previous adverse reactions
to ACE inhibitors.
- People with high
potassium levels in the blood that cannot be
controlled. These drugs may further increase potassium levels in the
- People with very low blood pressure, especially if their low
blood pressure causes dizziness or weakness when they stand up. ACE inhibitors
lower blood pressure.
- People with certain kidney problems. ACE
inhibitors can make kidney function worse in people who have the kind of kidney
disease caused by narrowed blood vessels (renovascular
How Well It Works
In people who have symptoms of heart failure
ACE inhibitors can:1
- Relieve symptoms.
- Lower risk of death.
- Lower risk of being hospitalized for heart failure.
In people who may not have symptoms of heart failure but who have had a heart attack
ACE inhibitors are often started in
people who have recently had a heart attack and who have a damaged or weakened
left ventricle but who do not yet have symptoms of heart failure. In these
people, ACE inhibitors have been found to reduce death rates when started soon
after the heart attack.1
Side effects of ACE inhibitors may
- A dry cough (common).
- A rash or
- Symptoms like those from allergies.
allergic reaction with generalized swelling (angioedema).
potassium in the body (hyperkalemia), especially in people who have kidney
- Low blood pressure, especially when first starting on ACE
- Kidney problems.
ACE inhibitors may interact with 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 taking any other medicines.
See Drug Reference
for a full list of side effects. (Drug Reference is not available in all
What To Think About
Usually, ACE inhibitors cause
very few side effects. The most common side effect is an irritating dry cough.
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. ARBs have been
shown to work as well as ACE inhibitors for heart failure.2
ACE inhibitors are one of the first choices in
drugs for treating heart failure.
Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
Hunt SA, et al. (2009). 2009 focused update
incorporated into the ACC/AHA 2005 guidelines for the diagnosis and management
of heart failure in adults. A report of the American College of Cardiology
Foundation/American Heart Association Task Force on Practice Guidelines.
Circulation, 119(14): e391-e479.
McKelvie R (2010). Heart failure, search date May 2009. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.