Angiotensin-converting enzyme (ACE) inhibitors for coronary artery disease

Examples

Generic Name	Brand Name
benazepril hydrochloride	Lotensin
captopril	Capoten
enalapril maleate	Vasotec
fosinopril sodium	Monopril
lisinopril	Prinivil, Zestoretic, Zestril
perindopril	Coversyl
quinapril hydrochloride	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 chances of heart attack.

Why It Is Used

ACE inhibitors are recommended for people who have coronary artery disease, particularly those who also have diabetes. Also, if an ACE inhibitor is not already used, it is usually prescribed immediately after a heart attack. Studies have shown that ACE inhibitors save lives and reduce the risk of heart attack and stroke in people with CAD.¹ These drugs frequently are also used to treat high blood pressure and heart failure.

How Well It Works

ACE inhibitors, if used within 24 hours of the start of heart attack symptoms, appear to reduce the risk of death associated with the heart attack.² Use of ACE inhibitors following a heart attack can also help prevent the development of heart failure related to a heart attack.

The HOPE trial (the Heart Outcomes Prevention Evaluation trial) concluded that ramipril (Altace) reduced the rate of death, heart attack, and stroke in people who were at high risk for these problems but who did not have any signs of heart failure or other abnormal heart function. This study suggests that, in addition to people who already have known abnormal heart function or heart failure, people at high risk for a heart attack or sudden death from coronary artery disease also may benefit from taking ramipril.³

A similar study conducted in Europe (the EUROPA study) found a similar benefit from perindopril (Aceon) in people with a moderate to high risk of a heart attack or sudden death from coronary artery disease. However, the EUROPA study showed the benefit is not apparent until the medication has been taken for 1 year or longer.⁴

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 medication. If coughing is a severe problem, other medications 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 medication and need to have their blood pressure monitored regularly.
• Swelling. Swelling in the face, neck, lips, throat, hands, feet, or genitals rarely may occur when using 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, leading 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

Angiotensin II receptor blockers (ARBs) such as losartan, valsartan, and irbesartan (approved for high blood pressure) do not cause a cough. If a person is taking an ACE inhibitor and coughing is a significant problem, then an angiotensin II receptor blocker (ARB) may be used instead.

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Author:	Douglas Dana Robin Parks, MS	Last Updated: September 21, 2007
Medical Review:	Anne C. Poinier, MD - Internal Medicine Caroline S. Rhoads, MD - Internal Medicine Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology Robert A. Kloner, MD, PhD - Cardiology Ruth Schneider, MPH, RD - Diet and Nutrition
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