ACE inhibitors
Angiotensin-converting enzyme inhibitors
If you cough a lot, often feel weak, have lost your appetite, and need to urinate a lot at night, you might have symptoms of heart failure. Heart failure is a long-term condition that usually comes on slowly. However, it can develop suddenly, for instance, after a heart attack. You have heart failure when your heart does not pump blood out of your heart very well, or when your heart muscles are stiff and do not easily fill up with blood. When you have heart failure, your heart cannot pump enough oxygen-rich blood to the rest of your body, especially when you exercise or move around a lot. As the heart loses the ability to pump blood, blood backs up in other parts of your body, including your lungs, liver, gastrointestinal tract, and your arms and legs. The most common cause of heart failure is coronary artery disease, the narrowing of the blood vessels that supply blood and oxygen to your heart. So, how do you know if you have heart failure? Get to your doctor. You may have trouble breathing, an irregular heartbeat, swollen legs, neck veins that stick out, and sounds from fluid built up in your lungs. Your doctor will check for these and other signs of heart failure. A test called an echocardiogram is often the best test to diagnose your heart failure. Your doctor can also use this test to find out why you have heart failure, and then monitor your condition going forward every three to six months. Your doctor will talk to you about knowing your body and symptoms that mean your heart failure is getting worse. You will need to learn to watch for changes in your heart rate, pulse, blood pressure, and weight. You will also need to limit salt in your diet, stop drinking alcohol, quit smoking if you need to, exercise, lose weight if you need to, and get enough rest. Your doctor will probably ask you to take medicines to treat your heart failure. These medicines can treat your symptoms, prevent your heart failure from getting worse, and help you live longer. If you have heart failure, taking your medicines, changing your lifestyle, and treating the condition that caused heart failure can go a long way toward improving your health. But heart failure is a chronic, or long-term, illness, which means it may get worse over time. Make sure you call your doctor if you start coughing more, have sudden weight gain or swelling, or feel week. Have someone take you to the emergency room right away if you have trouble with fainting, a fast and irregular heartbeat, or feel severe crushing chest pain.
A stroke involves loss of brain functions caused by a loss of blood circulation to areas of the brain. The blockage usually occurs when a clot or piece of atherosclerotic plaque breaks away from another area of the body and lodges within the vasculature of the brain.
Diabetes is on the rise worldwide, and is a serious, lifelong disease that can lead to heart disease, stroke, and lasting nerve, eye and foot problems. Let's talk about diabetes and the difference between the three types of diabetes. So, what exactly is diabetes and where does it come from? An organ in your body called the pancreas produces insulin, a hormone that controls the levels of your blood sugar. When you have too little insulin in your body, or when insulin doesn't work right in your body, you can have diabetes, the condition where you have abnormally high glucose or sugar levels in your blood. Normally when you eat food, glucose enters your bloodstream. Glucose is your body's source of fuel. Your pancreas makes insulin to move glucose from your bloodstream into muscle, fat, and liver cells, where your body turns it into energy. People with diabetes have too much blood sugar because their body cannot move glucose into fat, liver, and muscle cells to be changed into and stored for energy. There are three major types of diabetes. Type 1 diabetes happens when the body makes little or no insulin. It usually is diagnosed in children, teens, or young adults. But about 80% of people with diabetes have what's called Type 2 diabetes. This disease often occurs in middle adulthood, but young adults, teens, and now even children are now being diagnosed with it linked to high obesity rates. In Type 2 diabetes, your fat, liver, and muscle cells do not respond to insulin appropriately. Another type of diabetes is called gestational diabetes. It's when high blood sugar develops during pregnancy in a woman who had not had diabetes beforehand. Gestational diabetes usually goes away after the baby is born. But, still pay attention. These women are at a higher risk of type 2 diabetes over the next 5 years without a change in lifestyle. If you doctor suspects you have diabetes, you will probably have a hemoglobin A1c test. This is an average of your blood sugar levels over 3 months. You have pre-diabetes if your A1c is 5.7% to 6.4%. Anything at 6.5% or higher indicates you have diabetes. Type 2 diabetes is a wake up call to focus on diet and exercise to try to control your blood sugar and prevent problems. If you do not control your blood sugar, you could develop eye problems, have problems with sores and infections in your feet, have high blood pressure and cholesterol problems, and have kidney, heart, and problems with other essential organs. People with Type 1 diabetes need to take insulin every day, usually injected under the skin using a needle. Some people may be able to use a pump that delivers insulin to their body all the time. People with Type 2 diabetes may be able to manage their blood sugar through diet and exercise. But if not, they will need to take one or more drugs to lower their blood sugar levels. The good news is, people with any type of diabetes, who maintain good control over their blood sugar, cholesterol, and blood pressure, have a lower risk of kidney disease, eye disease, nervous system problems, heart attack, and stroke, and can live, a long and healthy life.
How ACE inhibitors help
ACE inhibitors are used to treat heart disease and high blood pressure. These medicines make your heart work less hard by lowering your blood pressure. This keeps some kinds of heart disease from getting worse. Most people who have heart failure take one of these medicines or similar medicines.
These medicines treat high blood pressure, strokes, or heart attacks. They may help lower your risk for stroke or heart attack.
They are also used to treat kidney problems. This can help keep your kidneys from getting worse or even improve the function of your kidneys, especially if you have diabetes. If you have these problems, ask your health care provider if you should be taking these medicines.
Types of ACE inhibitors
There are many different names and brands of ACE inhibitors. Most work as well as another. Side effects may be different for different ones.
Taking Your ACE inhibitors
ACE inhibitors are pills that you take by mouth. Take all of your medicines as your provider told you to. Follow up with your provider regularly. Your provider will check your blood pressure and do blood tests to make sure the medicines are working properly. Your provider may change your dose from time to time. In addition:
- Try to take your medicines at the same time each day.
- Don't stop taking your medicines without talking to your provider first.
- Plan ahead so that you do not run out of medicine. Make sure you have enough with you when you travel.
- Before taking ibuprofen (Advil, Motrin) or aspirin, talk to your provider.
- Tell your provider what other medicines you are taking, including anything you bought without a prescription, diuretics (water pills), potassium pills, or herbal or dietary supplements.
- Don't take ACE inhibitors if you are planning to become pregnant, are pregnant, or are breastfeeding. Contact your provider promptly if you become pregnant when you are taking these medicines.
Side effects
Side effects from ACE inhibitors are unusual.
You may have a dry cough. This may go away after a while. It also may start after you have been taking the medicine for some time. Tell your provider if you develop a cough. Sometimes reducing your dose helps. But sometimes, your provider will switch you to a different medicine. Do not lower your dose without talking with your provider first.
You may feel dizzy or lightheaded when you start taking these medicines, or if your provider increases your dose. Standing up slowly from a chair or your bed may help. If you have a fainting spell, contact your provider right away.
Other side effects include:
- Headache
- Fatigue
- Loss of appetite
- Upset stomach
- Diarrhea
- Numbness
- Fever
- Skin rashes or blisters
- Joint pain
If your tongue or lips swell, contact your provider right away, or go to the emergency room. You may be having a serious allergic reaction to the medicine. This is very rare.
When to Call the Doctor
Contact your provider if you are having any of the side effects listed above. Also contact your provider if you are having any other unusual symptoms.
References
Mann DL. Management of heart failure patients with reduced ejection fraction. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 50.
Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the management of heart failure: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145(18):e895-e1032. PMID: 35363499
Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71(19):e127-e248. PMID: 29146535
Version Info
Last reviewed on: 8/5/2024
Reviewed by: Thomas S. Metkus, MD, Assistant Professor of Medicine and Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
