ACE inhibitors

Mode of action of ACE inhibitor medication for high blood pressure

ACE inhibitors such as captopril, enalapril, ramipril and others are also first-line medications for treating high blood pressure. They are used either alone (as monotherapy) or, preferably, together with other blood pressure medications (as combination therapy). In people with chronic heart failure, ACE inhibitors can slow the worsening of the disease and prolong life. This is thought to be due to ACE inhibitor therapy reducing the heart's afterload. ACE inhibitors are also used after heart attacks or myocarditis; among other effects, they prevent damaged heart muscle cells from being converted into connective tissue.

What do ACE inhibitors block?

ACE inhibitors block a specific enzyme (angiotensin-converting enzyme) and thereby interrupt a chain of protein conversions. By inhibiting this enzyme, less angiotensin II is produced; angiotensin II normally causes the blood vessel muscles to contract and increases the release of aldosterone. Because the vessels dilate and more fluid is excreted, blood pressure falls. However, the breakdown of a hormone is also inhibited, leading to increased bradykinin in the body, which is partly responsible for the sometimes unpleasant dry cough that occurs during ACE inhibitor therapy.
Unlike beta blockers or calcium channel blockers, ACE inhibitors do not affect the heart's electrical conduction and therefore have no effect on the heartbeat.

ACE inhibitors: Side effects

Because bradykinin acts similarly to histamine, it can cause a range of side effects such as fluid accumulation (one feared reaction is angioedema, which causes swelling of the skin and mucous membranes, especially around the face and throat) and a persistent dry cough. This dry cough is completely harmless but can be very annoying; it may not occur until after prolonged treatment and often leads to stopping the medication.

Because the lower aldosterone level increases potassium uptake, blood potassium levels can also rise. This must be considered especially in patients with impaired kidney function and in those taking certain other medications at the same time.
ACE inhibitors can damage the liver and, in very rare cases, cause acute liver failure.

It is not uncommon at the start of treatment to experience symptoms such as dizziness from the rapid drop in blood pressure. Gastrointestinal complaints, headaches, changes in taste, muscle problems and various other general symptoms can also occasionally occur.
For a full list of possible side effects, please also read the manufacturer's information leaflet that comes with your medicine.
Your doctor must also always consider possible interactions when you are taking other medications.

ACE inhibitors: Active substances

Benazepril, Captopril, Cilazapril, Enalapril, Fosinopril, Lisinopril, Moexipril, Perindopril, Quinapril, Ramipril, Trandolapril

ACE inhibitors: Active substances and approved drugs

Wirkstoff	Produkte
Benazepril	Benazeplus Kombipräparat, Benazepril, Cibacen, Cibadrex Kombipräparat
Captopril	ACE-Hemmer-Ratiopharm, Capto comp Kombipräparat, Capto-CT, Captobeta, Captogamma, CaptoHEXAL Kombipräparat, Captopril Kombipräparat, Tensobon
Cilazapril	Dynorm
Enalapril	Benalapril, Carmen Kombipräparat, Corvo, Ena-Lerca Kombipräparat, Enabeta Kombipräparat, EnaCanpin Kombipräparat, EnaHEXAL, Enala-Q comp Kombipräparat, Enalagamma Kombipräparat, Enalapril, Enaplus Kombipräparat, Eneas Kombipräparat, Jutaxan, Lercaprel Kombipräparat, Renacor Kombipräparat, Xanef, Zaneril Kombipräparat, Zanipress Kombipräparat
Fosinopril	Dynacil, Fosino-Teva, Fosinopril, Fosinorm
Lisinopril	Acercomp Kombipräparat, Lisi Lich, Lisi TAD HCT Kombipräparat, Lisibeta, Lisigamma, LisiHEXAL, Lisinopril, Lisiplus Kombipräparat
Moexipril	Fempress plus Kombipräparat
Perindopril	Bipreterax Kombipräparat, Coversum, Perindopril Kombipräparat, Preterax Kombipräparat, Rindecombi Kombipräparat, Stapressial Kombipräparat, Triveram Kombipräparat, Viacoram Kombipräparat
Quinapril	Accupro, Accuzide Kombipräparat, Quinaplus Kombipräparat, Quinapril
Ramipril	Arelix Kombipräparat, Delix Kombipräparat, Delmuno Kombipräparat, Iltria Kombipräparat, Rami-Q, Ramiclair Kombipräparat, RamiDipin Kombipräparat, RamiGamma, RamiLich, Ramiplus Kombipräparat, Ramipril Kombipräparat, Ramitanid Kombipräparat, Sincronium, Tonotec Kombipräparat, Triapin Kombipräparat
Trandolapril	Tarka Kombipräparat, Udrik
Zofenopril	Zofenil

Sources:

This article is from Tensana – the leading app since 2011, helping hundreds of thousands of people monitor their blood pressure every day. Our content is based on carefully researched, evidence-based data and is continuously updated (as of 12/2025).

Author Sabine Croci is a qualified medical assistant with many years of experience in internal medicine and cardiology practices as well as outpatient care, and has headed the specialist editorial team at Tensana since 2015. Thanks to her extensive additional qualifications as an emergency medical technician, first responder, and in various areas of therapy and emergency care, she provides well-founded, practical, and reliably verified information.

We hope you found the article helpful. For good blood pressure control, it's important to take your medications correctly. Our app Tensana will gladly remind you when to take them. It also keeps track of your medication supply and notifies you in time when you're running low. This feature is fully available in the free version as well. Get the free app now.