Cookies on the Bupa website

We use cookies to help us understand ease of use and relevance of content. This ensures that we can give you the best experience on our website. If you continue, we'll assume that you are happy to receive cookies for this purpose. Find out more about cookies

Continue

Navigation

ACE inhibitors and angiotensin II receptor blockers

Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) work on the systems in your body that control your blood pressure. They’re often used to treat high blood pressure, heart and kidney problems.

This information is for you if:

  • your doctor has recently advised you to take ACE inhibitors or angiotensin II receptor blockers and you’re deciding whether to take them or not
  • you’re currently taking ACE inhibitors or ARBs and would like more information about them, particularly about side-effects
An image showing a laptop

Details

  • Why take ACE inhibitors and ARBs? Why has my doctor suggested an ACE inhibitor or ARB?

    Your doctor will have offered to prescribe ACE inhibitors or ARBs to lower your blood pressure if you have:

  • How they work How do ACE inhibitors and ARBs work?

    There are systems in your body that work together to keep your blood pressure high enough to get sufficient oxygen and nutrients around your body. ACE inhibitors and ARBs lower your blood pressure by acting on one of these systems – the renin–angiotensin–aldosterone system.

    Sensors in your kidneys can detect when your blood pressure drops too low. When this happens, a chemical called angiotensin I is released into your blood. This reacts with the angiotensin-converting enzyme in your blood, and is converted into angiotensin II. Enzymes are protein molecules that speed up chemical reactions.

    Angiotensin II narrows your blood vessels. It also acts on your adrenal glands (that produce hormones) to trigger the release of a hormone called aldosterone. Aldosterone makes your body hold on to water. The extra volume of fluid in your blood and the narrowing of your blood vessels causes your blood pressure to rise.

    Here’s how ACE inhibitors and ARBs work on this system.

    • ACE inhibitors block the action of angiotensin-converting enzyme so that angiotensin I isn't converted to angiotensin II.
    • ARBs block the action of angiotensin II.

    Without the action of angiotensin II, your blood vessels become more relaxed and you don’t release the hormone aldosterone, so your blood pressure is reduced.

    ACE inhibitors and ARBs can also protect your kidneys. If you have kidney disease, damage occurs to your kidneys and protein is lost in your urine. Lowering your blood pressure can prevent damage to your kidneys.

  • Types of ACE inhibitor and ARB Which ACE inhibitor or ARB will my doctor prescribe?

    There are lots of different ACE inhibitors and ARBs. Your doctor will normally decide which is best for you after considering a number of factors. These include what condition you have, how effective the medicine is, and the cost. The most common ACE inhibitor is called ramipril, and the most common ARB is called candesartan. Ask your doctor which type of medicine is best for you.

  • Taking the medicine How do I take ACE inhibitors or ARBs?

    You take ACE inhibitors or ARBs as tablets, usually once a day. When you have your first dose, it’s best to take it at night. If everything is well and you don’t get bad side-effects, you can take the tablets every morning.

    You might need to take more than one medicine at the same time. For example, your doctor might prescribe a diuretic or a calcium-channel blocker in combination with an ACE inhibitor.

  • Monitoring Monitoring your health

    How often will I need check-ups?

    Your doctor will ask you to have a blood test before you start taking ACE inhibitors or ARBs. They’ll test you again a week or two after you first start taking the medicine, or if they increase your dose. After this, your doctor will test you every year.

    These tests are to check that your kidneys are healthy, and that your blood pressure is responding well to your medicine. After these tests, your doctor may change the type or dose of your ACE inhibitor or ARB. They might even change to a different medicine to make sure you’re getting the right treatment for you.

    Will I have to take ACE inhibitors and ARBs for life?

    Yes, you’ll usually need to take ACE inhibitors or ARBs on a long-term basis, with on-going monitoring. If you stop taking them, it’s likely you’ll stop getting the benefits. This is a big commitment and change to your lifestyle, so it’s important that you talk the pros and cons through with your doctor to make a decision you’re happy with.

    It’s also important to improve your lifestyle with diet and exercise. This can improve your health condition so you might be able to take a lower dose of medicine. See our Related information for tips and advice on how to improve your diet and get more active.

  • Suitability Can anyone take ACE inhibitors and ARBs?

    ACE inhibitors and ARBs aren’t the right treatment for everyone.

    If you're pregnant or breastfeeding, you won’t be able to take ACE inhibitors or ARBs because they may harm your baby. If you’re taking ACE inhibitors or ARBs and want to try for a baby, speak to your doctor first.

    If you’re over 55 or are African or Caribbean, ACE inhibitors and ARBs might not work so well for you. Your doctor will probably give you a different medicine. See our FAQ: Suitability of ACE inhibitors for more information on why.

    ACE inhibitors or ARBs may not be the right treatment if you have a narrowing of the arteries that supply your kidneys (renal artery stenosis). This is because these medicines may affect the way your kidneys work. Your doctor might ask you to have a blood test before you start taking them and further tests while you’re taking them. This is to check how well your kidneys are working and if you have this problem.

  • Interactions Interactions with ACE inhibitors and ARBs

    Check with your doctor or pharmacist before you take any other medicines at the same time as ACE inhibitors or ARBs.

    Some medicines can enhance the effects of ACE inhibitors and ARBs so you might get very low blood pressure (hypotension). Other medicines that raise the potassium level in your blood can also cause problems if you take them together with ACE inhibitors or ARBs.

    You can’t usually take both ACE inhibitors and ARBs together.

  • Side-effects Side-effects of ACE inhibitors and ARBs

    We haven’t included all the possible side-effects here. To understand all the side-effects of the medicine you’re taking, have a look at your patient information leaflet which will detail them all. ARBs usually cause milder side-effects than ACE inhibitors.

    Common side-effects

    One in 10 people may get side-effects such as:

    • low blood pressure
    • a reduction in kidney function
    • a persistent dry cough if you take ACE inhibitors (you don’t usually get this side-effect with ARBs)

    Uncommon side-effects

    One in 100 people may get side-effects such as:

    • tiredness
    • headache
    • dizziness
    • a skin rash
    • cold-like symptoms
    • feeling sick or vomiting
    • indigestion
    • diarrhoea or constipation
    • tummy ache
    • swelling underneath your skin

    What to do if you get side-effects

    If you get a cough or other side-effects with ACE inhibitors, let your doctor know. They may offer to prescribe you ARBs instead. If you get side-effects with ARBs, your doctor can discuss other options with you.

  • FAQ: ARBs and cancer Do ARBs increase the risk of cancer?

    Do angiotensin II receptor blockers (ARBs) increase your risk of cancer?

    Answer

    No, ARBs don't increase your risk of cancer.

    Explanation

    In 2010, a study suggested that people taking ARBs had a slightly increased risk of cancer compared to those not taking the medicine. The researchers had looked at information from five clinical trials.

    Since then, there have been three more reviews of all relevant clinical trials, including data from many more studies and thousands of patients. All three found no evidence to suggest ARBs increased the risk of cancer.

    If you're taking ARBs and have any concerns, it's important to talk to your doctor or the healthcare professional who prescribed your medicine.

  • FAQ: Alcohol with ACE inhibitors and ARBs Can I drink alcohol with ACE inhibitors or ARBs?

    Alcohol temporarily relaxes your blood vessels and slows your heart rate (although over a longer period alcohol will increase your blood pressure). If you’re taking ACE inhibitors or ARBs, alcohol can temporarily enhance the effects and lower your blood pressure too much.

    Low blood pressure is a common side-effect in people taking ACE inhibitors and ARBs and drinking alcohol makes this even more likely to happen. It can be dangerous if your blood pressure drops too much. It’s important to check with your doctor if you can drink alcohol when taking an ACE inhibitor or an ARB.

  • FAQ: ACE inhibitors and diabetes How do ACE inhibitors help people with diabetes?

    If you have diabetes, ACE inhibitors help to protect your kidneys from becoming damaged as a result of your condition.

    With diabetes, you’re more at risk of getting kidney disease. This is because the high levels of glucose associated with diabetes can damage the small blood vessels in your kidneys.

    High blood pressure can cause further damage to your kidneys. So if you have diabetes, it’s especially important to keep your blood pressure under control. If you have early signs of kidney disease or high blood pressure, your doctor will usually prescribe an ACE inhibitor. They seem to offer better protection against kidney disease than other medicines for high blood pressure.

  • FAQ: Suitability of ACE inhibitors Who can and can’t take ACE inhibitors?

    ACE inhibitors aren’t the best choice of treatment for everybody. They don’t reduce blood pressure in people over 55, and they don’t work as well in people with an African or Caribbean background.

    ACE inhibitors seem to work better in younger people. This may be because people under 55 have a higher level of (and are more sensitive to) an enzyme called renin in their bodies. Renin is made by your kidneys and plays a key role in controlling your blood pressure. ACE inhibitors affect the renin–angiotensin system and it is thought this is why they have a better effect in younger people, while older people don’t respond so well.

    ACE inhibitors are also not as effective at lowering blood pressure in people with from African or Caribbean ethnic groups. This is because they also tend to have lower levels of renin.

    If you have high blood pressure and are over 55, or are African or Caribbean, your doctor will try another medicine first. They’ll usually prescribe a calcium-channel blocker or a diuretic.

  • Resources Resources

    Further information

    Sources

    • Angiotensin-converting enzyme inhibitors. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, accessed 12 October 2016
    • Angiotensin-II receptor antagonists. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, accessed 12 October 2016
    • Angiotensin-converting enzyme inhibitors. PatientPlus. patient.info/patientplus, last checked 1 December 2014
    • Pathophysiology of hypertension. Medscape. emedicine.medscape.com, updated 28 December 2015
    • Alberts B, Johnson A, Lewis J, et al. Molecular biology of the cell. 4th ed. New York: Garland Science; 2002
    • Hypertension medication. Medscape. emedicine.medscape.com, updated 27 November 2016
    • Chronic kidney disease. BMJ Best Practice. bestpractice.bmj.com, last updated 18 October 2016
    • Hypertension – not diabetic. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised October 2015
    • Personal communication, Dr Tim Cripps, Consultant Cardiologist, Spire Bristol Hospital, 25 October 2016
    • Getting the most from your blood pressure medicines. Blood Pressure UK. www.bloodpressureuk.org, published 2008
    • List of drug interactions: Angiotensin-II receptor antagonists. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, accessed 12 October 2016
    • List of drug interactions: ACE inhibitors. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, accessed 12 October 2016
    • Adverse reactions to drugs. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, accessed 14 October 2016
    • Ethanol toxicity. Medscape. emedicine.medscape.com, updated 29 December 2015
    • Assessment of hypertension. BMJ Best Practice. bestpractice.bmj.com, last updated 30 November 2016
    • Angiotensin II receptor antagonists: evidence does not suggest any link with cancer. Medicines and Healthcare Products Regulatory Agency. www.gov.uk, published 12 December 2011
    • Diabetic nephropathy. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, accessed 12 October 2016
    • Diabetic nephropathy. Medscape. emedicine.medscape.com, updated 30 September 2016
    • Hypertension and heart failure. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, accessed 12 October 2016
    • Hypertension. Medscape. emedicine.medscape.com, updated 27 November 2016
    • Statement on quality and outcomes framework (QOF) and EGFR. Kidney Research UK. www.kidneyresearchuk.org, accessed 13 October 2016
    • Drug cabinet: ACE inhibitors. British Heart Foundation. www.bhf.org.uk, accessed 12 October 2016
  • Has our information helped you? Tell us what you think about this page

    We’d love to know what you think about what you’ve just been reading and looking at – we’ll use it to improve our information. If you’d like to give us some feedback, our short form below will take just a few minutes to complete. And if there's a question you want to ask that hasn't been answered here, please submit it to us. Although we can't respond to specific questions directly, we’ll aim to include the answer to it when we next review this topic.

    Let us know what you think using our short feedback form
    Ask us a question
  • Related information Related information

  • Author information Author information

    Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, December 2016

    Expert reviewer Dr Tim Cripps, Consultant Cardiologist

    Next review due December 2019

About our health information

At Bupa we produce a wealth of free health information for you and your family. We believe that trustworthy information is essential in helping you make better decisions about your health and care. Here are just a few of the ways in which our core editorial principles have been recognised.

  • Information Standard

    We are certified by the Information Standard. This quality mark identifies reliable, trustworthy producers and sources of health information.
    Information standard logo
  • HONcode

    This site complies with the HONcode standard for trustworthy health information: verify here.

    This website is certified by Health On the Net Foundation. Click to verify.

What our readers say about us

But don't just take our word for it; here's some feedback from our readers.

Simple and easy to use website - not alarming, just helpful.

It’s informative but not too detailed. I like that it’s factual and realistic about the conditions and the procedures involved. It’s also easy to navigate to areas that you specifically want without having to read all the information.

Good information, easy to find, trustworthy.

Meet the team

Image of Andrew Byron

Andrew Byron
Head of health content and clinical engagement




  • Dylan Merkett – Lead Editor – UK Customer
  • Nick Ridgman – Lead Editor – UK Health and Care Services
  • Natalie Heaton – Specialist Editor – User Experience
  • Pippa Coulter – Specialist Editor – Content Library
  • Alice Rossiter – Specialist Editor – Insights
  • Laura Blanks – Specialist Editor – Quality
  • Michelle Harrison – Editorial Assistant

Our core principles

All our health content is produced in line with our core editorial principles – readable, reliable, relevant – which are represented by our diagram.

An image showing or editorial principals

                  Click to open full-size image

The ‘3Rs’ encompass everything we believe good health information should be. From tweets to in-depth reports, videos to quizzes, every piece of content we produce has these as its foundation.

Readable

In a nutshell, our information is jargon-free, concise and accessible. We know our audience and we meet their health information needs, helping them to take the next step in their health and wellbeing journey.

Reliable

We use the best quality and most up-to-date evidence to produce our information. Our process is transparent and validated by experts – both our users and medical specialists.

Relevant

We know that our users want the right information at the right time, in the way that suits them. So we review our content at least every three years to keep it fresh. And we’re embracing new technology and social media so they can get it whenever and wherever they choose.

Our accreditation

Here are just a few of the ways in which the quality of our information has been recognised.

  • The Information Standard certification scheme

    You will see the Information Standard quality mark on our content. This is a certification programme, supported by NHS England, that was developed to ensure that public-facing health and care information is created to a set of best practice principles.

    It uses only recognised evidence sources and presents the information in a clear and balanced way. The Information Standard quality mark is a quick and easy way for you to identify reliable and trustworthy producers and sources of information.

    Certified by the Information Standard as a quality provider of health and social care information. Bupa shall hold responsibility for the accuracy of the information they publish and neither the Scheme Operator nor the Scheme Owner shall have any responsibility whatsoever for costs, losses or direct or indirect damages or costs arising from inaccuracy of information or omissions in information published on the website on behalf of Bupa.

  • British Medical Association (BMA) patient information awards

    We have received a number of BMA awards for different assets over the years. Most recently, in 2013, we received a 'commended' award for our online shared decision making hub.

Contact us

If you have any feedback on our health information, we would love to hear from you. Please contact us via email: healthinfo@bupa.com. Or you can write to us:

Health Content Team
Bupa House
15-19 Bloomsbury Way
London
WC1A 2BA

Find out more Close

Legal disclaimer

This information was published by Bupa's Health Content Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition.

The information contained on this page and in any third party websites referred to on this page is not intended nor implied to be a substitute for professional medical advice nor is it intended to be for medical diagnosis or treatment. Third party websites are not owned or controlled by Bupa and any individual may be able to access and post messages on them. Bupa is not responsible for the content or availability of these third party websites. We do not accept advertising on this page.

For more details on how we produce our content and its sources, visit the 'About our health information' section.

ˆ We may record or monitor our calls.