ACE inhibitors and angiotensin II receptor blockers Q&As
Published by Bupa's health information team, September 2009.
Answers to questions about ACE inhibitors and angiotensin II receptor blockers
This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.
- Why does my age affect whether I am prescribed ACE inhibitors and angiotensin II receptor blockers (ARBs)?
- How do ACE inhibitors help people with diabetes?
- Can I drink alcohol while taking ACE inhibitors or angiotensin II receptor blockers?
Why does my age affect whether I am prescribed ACE inhibitors and angiotensin II receptor blockers (ARBs)?
ACE inhibitors may not be so effective at reducing blood pressure in people over the age of 55. If you are aged 55 or over, your doctor will try to control your blood pressure with another type of medicine first.
Explanation
ACE inhibitors seem to be better at lowering blood pressure in younger people. This is thought to be because younger people with high blood pressure seem to have a higher level of a chemical called renin in their body. The body needs renin to make angiotensin I - the substance that is converted into angiotensin II in the body. It is angiotensin II that can raise your blood pressure.
Medicines such as ACE inhibitors that affect the renin-angiotensin system are therefore thought to have more effect in younger people than in older people who don't have so much renin.
ACE inhibitors are not as effective in African-Caribbean people for the same reason - because people in this ethnic group tend to have lower levels of renin than caucasian people.
If you have high blood pressure and are over 55 or are African-Caribbean, your GP will usually prescribe a diuretic or a calcium-channel blocker first, to try to control your blood pressure. If you don't respond to this medicine, he or she may then also prescribe an ACE inhibitor or an ARB.
Sources
- Joint Formulary Committee. British National Formulary. 57th ed. London: British Medical Association and the Royal Pharmaceutical Society of Great Britain, 2009: 101
- Hypertension. Clinical Knowledge Summaries. www.cks.nhs.uk, accessed 15 June 2009
- Hypertension: Management of hypertension in adults in primary care. National Institute for Health and Clinical Excellence (NICE), 2006. www.nice.org.uk
How do ACE inhibitors help people with diabetes?
ACE inhibitors help to protect your kidneys if you have diabetes.
Explanation
If you have diabetes, you are at higher risk of getting kidney disease. This is because the high levels of glucose associated with diabetes can cause damage to the small blood vessels in your body, making your kidneys work less efficiently.
High blood pressure can cause further damage to your kidneys. So if you have diabetes, it is especially important to keep your blood pressure under control. ACE inhibitors are usually prescribed to control your blood pressure if you have diabetes, as they seem to offer better protection against kidney disease than other medicines for high blood pressure. Because of this, you will usually be prescribed an ACE inhibitor or an angiotensin II receptor blocker (ARB) if you have diabetes and tests have shown early signs of kidney disease, even if your blood pressure is normal.
As ACE inhibitors may help to prevent kidney disease whether or not you have high blood pressure, it has been suggested that they may have another action on the kidney, other than just lowering blood pressure. However, it is not clear at present what this may be, or whether their beneficial effects are just due to reducing blood pressure.
Sources
- Simon C, Everitt H, and Kendrick T, Oxford handbook of general practice. 2nd ed. Oxford: Oxford University Press, 2005: 416
- Type 2 Diabetes: the management of type 2 diabetes (update). National Institute for Health and Clinical Excellence (NICE), 2008. www.nice.org.uk
- Curtiss FR. What evidence supports guidelines for use of ACE inhibitors and ARBs in diabetes? Journal of Managed Care Pharmacy, 2006. 12(8): 690-691
Can I drink alcohol while taking ACE inhibitors or angiotensin II receptor blockers?
You should try to keep your alcohol intake to a minimum if you are taking ACE inhibitors or ARBs.
Explanation
If you drink alcohol after taking an ACE inhibitor or ARB, it can exaggerate the medicine's blood pressure-lowering effect. Your blood pressure may become too low. This is called hypotension. This is quite a common side-effect in people taking ACE inhibitors and ARBs and drinking alcohol makes it even more likely to happen.
This means that even if you don't usually get any side-effects from your medicine, when you drink alcohol, you may feel dizzy, light-headed or faint. You should try to keep your alcohol intake to a minimum if you are taking ACE inhibitors or ARBs. Ask your GP or pharmacist for advice if you're not sure how much you should be drinking.
Sources
- Joint Formulary Committee. British National Formulary. 57th ed. London: British Medical Association and the Royal Pharmaceutical Society of Great Britain, 2009: 100-108
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This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Publication date: September 2009
ACE inhibitors and ARBs factsheet
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