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

Examples

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 medicine 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 medicine. If coughing is a severe problem, other medicines 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 medicine 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

If you are pregnant or may become pregnant, do not take ACE inhibitors.

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.

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

References

Citations

1. Snow V, et al. (2004). Primary care management of chronic stable angina and asymptomatic suspected or known coronary artery disease: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 141(7): 562–567. Also available online: http://www.annals.org/cgi/reprint/141/7/562.pdf.
2. Danchin N, Durand E (2006). Acute myocardial infarction, search date August 2004. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.
3. Heart Outcomes Prevention Evaluation Study (HOPE) Investigators (2000). Effects of an angiotensin-converting enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. New England Journal of Medicine, 342(3): 145–153.
4. Fox KM (2003). Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: Randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study). Lancet: 362(9386): 782–788.