Angiotensin-Converting Enzyme (ACE) Inhibitors for Heart Failure

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Angiotensin-Converting Enzyme (ACE) Inhibitors for Heart Failure


Generic NameBrand Name
lisinoprilPrinivil, Zestril

ACE inhibitors combined with diuretic

Generic NameBrand Name
enalapril and hydrochlorothiazideVaseretic
lisinopril and hydrochlorothiazidePrinzide, Zestoretic

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 pressure.

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 against.

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

People with systolic heart failure, which is caused by left ventricular dysfunction, will probably be given an ACE inhibitor if possible.1

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 blood.
  • 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 disease).
  • Pregnant women.

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

All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. 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.

Here are some important things to think about:

  • Usually the benefits of the medicine are more important than any minor side effects.
  • Side effects may go away after you take the medicine for a while.
  • If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Call 911 or other emergency services right away if you have:

  • Trouble breathing.
  • Swelling of your face, lips, tongue, or throat.

Call your doctor if you have:

  • Hives.
  • Irregular heartbeats (which could be caused by too much potassium in your blood).
  • Dizziness or lightheadedness or fainting.

Common side effects of this medicine include:

  • Dry cough.
  • Headache.

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

What To Think About

ACE inhibitor cough

A cough is one of the most common side effects of ACE inhibitors. But most people do not get a cough. The cough tends to be a minor problem for most people who have it. They feel that they can live with it in exchange for the benefits of this medicine.

If you take an ACE inhibitor and have a problem with coughing, talk with your doctor. Your cough may be caused by something else, like a cold. Do not stop taking your medicine unless your doctor tells you to.

If you have a cough that is a problem for you, then your doctor might give you an angiotensin II receptor blocker (ARB) instead. ARBs are less likely to cause a cough.

Interactions with other medicines

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.

Taking medicine

Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.

There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.

For tips on taking medicine for heart failure, see:

Click here to view an Actionset.Heart Failure: Taking Medicines Properly.

Advice for women

Do not use this medicine if you are pregnant, breast-feeding, or planning to get pregnant. If you need to use this medicine, talk to your doctor about how you can prevent pregnancy.


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.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

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



  1. 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.


ByHealthwise Staff
Primary Medical ReviewerRakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
Specialist Medical ReviewerMargaret Hetherington, PHM, BsC - Pharmacy
Last RevisedApril 26, 2012

Last Revised: April 26, 2012

Author: Healthwise Staff

Medical Review: Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology & Margaret Hetherington, PHM, BsC - Pharmacy

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