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ACE inhibitors and angiotensin II receptor blockersThis factsheet is for people who would like information about taking ACE inhibitors or angiotensin II receptor blockers. Angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (sometimes called A2RBs) are medicines that lower blood pressure. They are used to treat high blood pressure and heart failure and to protect your kidneys from damage if you have diabetes.
Why would I take them?Your doctor may recommend ACE inhibitors or A2RBs if you have: What is high blood pressure?Your blood pressure is the force that your blood applies to the walls of your arteries as it flows through them. It's normal for blood pressure to increase when you exercise, or when you feel stressed or anxious. But if your blood pressure is consistently higher than normal then you have high blood pressure, or hypertension. For more information, please see the separate BUPA health factsheet, High blood pressure. How do ACE inhibitors and A2RBs work?There are control systems in your body that work together to keep your blood pressure at the level that's normal for you. This is a pressure that's high enough to get enough oxygen and nutrients around your body, but not so high that your blood vessels or organs get damaged. ACE inhibitors and A2RBs work on these control systems to lower your blood pressure. Sensors on your kidney can detect when your blood pressure drops too low. When this happens, angiotensin I is released into your blood. On its own, angiotensin I doesn't have much effect, but when angiotensin I meets ACE in the blood, angiotensin II is made. Angiotensin II has two effects. Firstly, it narrows your blood vessels - causing the pressure of the blood inside them to go up (a bit like squeezing a hose pipe). Secondly, angiotensin II triggers the release of a hormone called aldosterone. This tells your kidneys to get rid of less of the water in your urine. This extra water stays in your blood, increasing the overall volume of blood in your body. Your blood vessels don't get any bigger, so your blood pressure increases because there is a larger amount of blood squeezed into the same space. ACE inhibitors block the action of ACE so that although angiotensin I is made, it does not get converted to angiotensin II. So ACE inhibitors relax the walls of your blood vessels and lower your blood pressure. A2RBs interfere with the action of angiotensin II on blood vessels and also lower blood pressure. How to take ACE inhibitors and A2RBsACE inhibitors and A2RBs are only available on prescription. They usually come as tablets, which you will usually need to take once a day, as advised by your doctor. Many people with high blood pressure or heart trouble need to take more than one medicine. Your doctor may recommend that you take an ACE inhibitor in combination with other heart and blood pressure medicines, such as diuretics (water tablets). Do not stop taking an ACE inhibitor suddenly. This type of medicine needs to be reduced slowly, and on the advice of your doctor. Always read the patient information leaflet that comes with your medicine. Special careAs with all medicines, your doctor will take into account your medical history before prescribing an ACE inhibitor or A2RB. Both medicines may be unsuitable if you have a problem with the arteries that supply your kidneys (renal artery stenosis). If you are African-Caribbean, A2RBs may not work so for you, so your doctor may prescribe a different medicine. Side-effectsACE inhibitors and A2RBs can cause a big drop in your blood pressure. This can cause you to feel dizzy when you stand up. So, after taking a dose, you need to get up slowly from lying or sitting down and stay next to your chair or bed until you are sure that you are not feeling too dizzy. You should not drive (or do anything that needs you to be alert) until you know how you react to the medicine. The most common side-effect of ACE inhibitors is a long-lasting dry cough. Other, less common, side-effects of ACE inhibitors that you might notice are:
A2RBs cause fewer side-effects than ACE inhibitors, and do not cause a dry cough. Side-effects include feeling dizzy. For a full list of the possible side-effects, read the patient information leaflet that comes with your medicine. Your doctor can explain these to you in more detail. It's important to weigh up the low risk of side-effects with the good chance that your health will benefit from taking these medicines. Interactions with other medicinesCheck with your doctor or pharmacist before you take any other medicines or herbal remedies at the same time as an ACE inhibitor or an A2RB. Names of common ACE inhibitors and A2RBsExamples of the main types of ACE inhibitors and A2RBs are shown in the table. The generic name is the chemical name of a medicine. If a manufacturer has rights over a medicinal compound, it is given a brand name. Often there is more than one brand name associated with a generic name. Generic names are normally written with a lower-case initial letter and brand names normally start with an upper-case letter.
Further information
Sources
Published by BUPA's health information team, healthinfo@bupa.com, February 2007.
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