ACE inhibitors
- RAAS blockers → ↓ Ang II/aldosterone
- HTN, HFrEF, albuminuric CKD
- Strong outcomes data; inexpensive
- Cough/angioedema from bradykinin
- Hyperkalemia + creatinine rise possible
- Avoid in pregnancy/bilateral renal stenosis
- Do not routinely combine with an ARB
Class at a glance
- RAAS blockers → ↓ Ang II/aldosterone
Clinical role
- HTN, HFrEF, albuminuric CKD
- Strong outcomes data; inexpensive
Practical pearls
- Cough/angioedema from bradykinin
- Do not routinely combine with an ARB
Safety / monitoring
- Hyperkalemia + creatinine rise possible
- Avoid in pregnancy/bilateral renal stenosis
Pearls
- No ACE inhibitor clearly superior to another
- Angioedema more common in Black patients
- Contraindicated after any prior angioedema
- HF: titrate every 1–2 weeks; symptoms improve over weeks
- Lower mortality even in high-risk patients without HF
Self-check
- When should ACE inhibitors generally be avoided?
Pregnancy/bilateral renal stenosis. - Should ACE inhibitors routinely be combined with an ARB?
No.
Drugs in this class (10)
ACE inhibitors prescription history
Animated chart of estimated U.S. prescriptions per year, RAAS inhibitors (1981–2026). ACE inhibitors highlighted from 1981.
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