Angiotensin-converting enzyme (ACE) inhibitors are most commonly prescribed for high blood pressure (hypertension) and heart disease, but they can also be used to treat scleroderma, migraines, diabetes, kidney disease and even post-traumatic stress disorder (PTSD). Like any drug, ACE inhibitors can cause serious side effects. Understanding all the facts about this medication, as well as alternatives, can empower you to make informed decisions.
Monopril (fosinopril), Vasotec (enalapril), Capoten (captopril), Lotensin (benazepril), Accupril (quinapril), Zestril (lisinopril), Univasc (moexipril)
How They Work (Method of Action)
ACE inhibitors block the angiotensin-converting enzyme that relaxes blood vessels, lowering blood pressure. This also increases the amount of blood your heart pumps so that it doesn’t have to work as hard.
Side Effects and What to Do About Them
According to the U.S. National Library of Medicine, side effects are uncommon, but they can be severe and possibly fatal. The most common side effects are dizziness, headaches, dry cough, rash, fatigue, nausea and loss of taste. These symptoms may go away once you get used to the medication or your doctor may lower your dose or switch you to another kind.
More serious side effects can include fever, sore throat, swelling of the lower extremities, sores in the mouth, bruising, chest pain and irregular heartbeat. Let your doctor know if you experience any of these.
High potassium levels are another possible outcome of taking ACE inhibitors, so you will need regular blood tests to monitor your potassium level. Signs of too much potassium in your blood include irregular heartbeat, confusion, leg weakness, numbness in the hands, lips or feet, breathing difficulties and nervousness. This condition can be potentially life-threatening, so contact your doctor right away if you develop any of these symptoms.
Zestril (lisinopril) can cause an abdominal obstruction which can be life threatening. If it causes swelling in the intestines, that’s called angioedema which can be hard to diagnose. If you feel like you have a stomach flue, allergies, Crohn’s disease or appendicitis be sure to mention to your doctor that you are taking Zestril so that angioedema can be ruled out.
If you have severe vomiting or diarrhea, call your doctor since either of these can dehydrate you enough to cause low blood pressure.
If you experience swelling in your neck, face or tongue, this may be a serious allergic reaction and you need to get emergency help immediately.
Chase Rausch, 15, is on a very low dose of prazosin to help treat the PTSD that he suffered after receiving a severe concussion playing football. He says the medication slows down his heart rate so that he doesn’t dream anymore, which has stopped his night terrors, but it has also decreased his stamina for running.
Judy Olson, 64, has been on lisinopril for the past 20 years for her hypertension. She says the medication keeps her blood pressure controlled, though she does experience a cough that she describes as “tolerable.”
Several years ago, Michelle Haselhorst, 36, was on a low dose of lisinopril for 2 years to prevent kidney damage from her diabetes. She experienced dizziness and nausea if she stood up too fast or took a warm bath, so her doctor cut her dosage in half. Though decreasing her dose helped with those symptoms, she was still constantly losing her voice, a less common side effect. Her doctor decided to take her off lisinopril and her voice has been much better ever since.
Talk to your doctor before taking any nonsteroidal anti-inflammatory medications (NSAIDs), such as Advil (ibuprofen), Aleve (naproxen) or aspirin, as these can decrease the effectiveness of your ACE inhibitor. As with any prescription medication, let your doctor know about any other prescription or over-the-counter medications, supplements or herbs you are taking.
Effectiveness and Considerations
There are no big differences in the effectiveness of each drug, according to a Cochrane review of 92 ACE inhibitor trials. Additionally, the review found that 60-70% of the effect of lowering a patient’s blood pressure is found in the lowest recommended dose. This means that you can use the least expensive ACE inhibitor at a starting dose to minimize potential side effects while still getting the majority of the blood pressure lowering effect.
Pregnant women should not take ACE inhibitors as they can cause life-threatening conditions for the mother and birth defects in the baby.
Because ACE inhibitors can pass through breast milk, mothers should either not breastfeed while taking them or find another medication alternative.
Alternatives to ACE Inhibitors
There are natural ACE inhibitors you can add to your diet, such as pomegranate juice, flaxseed, beet-apple juice, vegetable juice, prunes, dark chocolate, hibiscus tea and blueberries. Pomegranates are also high in antioxidants which can improve and strengthen the arteries, and prevent blood from clotting. Foods high in flavonoids, such as grapes, berries, citrus fruit, beans, onions, broccoli, kale and Brussels sprouts, as well as foods containing vitamin E, like nuts, sunflower seeds and avocados, are also good for your heart and blood vessels. Keep in mind that foods are not as effective as medication for acute cases of high blood pressure, though they are certainly useful in helping to prevent hypertension in the first place.
The DASH (Dietary Approaches to Stop Hypertension) diet is another alternative to combat high blood pressure by committing to a lifetime of eating a healthy, balanced diet that’s low in sodium and rich in nutrients. This diet can also help you lose weight and prevent osteoporosis, heart disease, stroke, cancer and diabetes. If you’re already on an ACE inhibitor, implementing the DASH diet can supplement the medication’s effects, especially if you take a low dose.
Lifestyle changes like regular exercise, weight loss, reducing your stress and cutting back on alcohol, caffeine and/or smoking are other natural alternatives that can help you reduce your blood pressure.
Never decrease or discontinue your ACE inhibitor without medical supervision and always discuss any alternative treatment plan with your doctor before you start, even if it’s supplemental.