ACE Inhibitor drug for hypertension, side effects, to lower blood pressure, natural herbs, vitamins, and supplements
November 20 2017 by Ray Sahelian, M.D.

ACE inhibitor drugs belong to the class of medications called high blood pressure medicines. ACE stands for angiotensin converting enzyme. By inhibiting this enzyme an ACE  inhibitor drug is able to lower blood pressure. ACE inhibitors are commonly prescribed for high blood pressure and heart failure. They also prevent heart damage following a heart attack and reduce the risk of kidney problems in people with diabetes. See natural ways to treat hypertension.

Natural ACE Inhibitor pills
There are probably many plants and herbs that have compounds in them with ACE inhibitor activity.
 

Ashitaba
One such natural herb that has a substance with ACE inhibitor activity is ashitaba. Several teas have this potential.

Asparagus
J Agric Food Chem. 2013. Green asparagus (Asparagus officinalis) prevented hypertension by an inhibitory effect on angiotensin-converting enzyme activity in the kidney of spontaneously hypertensive rats. Green asparagus (Asparagus officinalis) is known to be rich in functional components. In the present study, spontaneously hypertensive rats (SHR) were used to clarify whether green asparagus prevents hypertension by inhibition of angiotensin-converting enzyme (ACE) activity. Six-week-old male SHR were fed a diet with (AD group) or without (ND group) 5% asparagus for 10 weeks. Systolic blood pressure (SBP), urinary protein excretion/creatinine excretion, and ACE activity in the kidney were significantly lower in the AD group compared with the ND group. Creatinine clearance was significantly higher in the AD group compared with the ND group. In addition, ACE inhibitory activity was observed in a boiling water extract of asparagus. The ACE inhibitor purified and isolated from asparagus was identified as 2″-hydroxynicotianamine. In conclusion, 2″-hydroxynicotianamine in asparagus may be one of the factors inhibiting ACE activity in the kidney, thus preventing hypertension and preserving renal function.

Mucuna pruriens herb
J Complement Integr Med. 2017. Mechanism of antihypertensive effect of Mucuna pruriens seed extract and its isolated compounds. Mucuna pruriens, traditionally, is used as diuretic and hypotensive. The study revealed the antihypertensive potential of MP seed compounds via ACE inhibition.

Pharm Biol. 2015. Angiotensin-converting enzyme (ACE) inhibitory potential of standardized Mucuna pruriens seed extract. It can be concluded that M. pruriens seed is a potential ACE inhibitor can be explored further as an effective antihypertensive agent.

Effects of green tea, black tea and rooibos tea on angiotensin-converting enzyme and nitric oxide in healthy volunteers
Public Health Nutrition Cambridge University Press 2010. Ingrid Persson, Karin Persson. Department of Medical and Health Sciences, Division of Drug Research / Pharmacology, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
Tea has been reported to reduce cardiovascular mortality, but the underlying mechanisms are largely unknown. The aim of the current project was to investigate the effect of green tea (Japanese Sencha), black tea (Indian Assam B.O.P.) and Rooibos tea (South Africa) on angiotensin-converting enzyme (ACE) and nitric oxide (NO). Seventeen healthy volunteers received a single oral dose of 400 ml green tea, black tea or Rooibos tea in a randomized, three-phase, crossover study. Oral intake of a single dose of Rooibos tea significantly inhibited ACE activity. A significant inhibition of ACE activity was seen with green tea for the ACE II genotype 30 min after intake of the tea and for the ACE ID genotype 60 min after intake). A significant inhibition of ACE activity was also seen with Rooibos tea for the ACE II genotype 60 min after intake. No significant effect on NO concentration was seen. These results suggest that green tea and Rooibos tea may have cardiovascular effects.

Am J Hypertension. 2007. Bovine casein hydrolysate (c12 Peptide) reduces blood pressure in prehypertensive subjects. About one in four adults suffer from prehypertension. People with prehypertension are at risk of developing hypertension, being a biomarker for cardiovascular disease risk. The use of milk-derived protein hydrolysates containing peptides with angiotensin-converting enzyme (ACE) inhibiting properties may reduce blood pressure (BP) and thus the risk of developing hypertension.

Indian J Pharmacology. 2015. Effects of aqueous extract of Hibiscus sabdariffa on the renin-angiotensin-aldosterone system of Nigerians with mild to moderate essential hypertension: A comparative study with lisinopril. The present study investigated the effects of aqueous extract of Hibiscus sabdariffa (HS) on the three basic components of renin-angiotensin-aldosterone system: Plasma renin, serum angiotensin-converting enzyme (ACE), and plasma aldosterone (PA) in mild to moderate essential hypertensive Nigerians and compared with that of lisinopril, an ACE inhibitor. HS reduced serum ACE and PA in mild to moderate hypertensive Nigerians with equal efficacy as lisinopril. These actions are possibly due to the presence of anthocyanins in the extract.

Pycnogenol supplement
Q. I have come across Pycnogenol where a few studies have shown to reduce BP and promote kidney function. However I have also read - "Pycnogenol acts as a natural ACE inhibitor, protects cell membranes from oxidative stress, increases nitric oxide, and improves endothelial function, and decreases hs-CRP."I wanted some feedback as to the validity of this claim. Does Pycnogenol in fact act in a similar fashion as an ACEi on the renin-angiotensin system?
   A. I have not done extensive reviews of this topic but based on the studies I have read thus far I have not seen specific reference to Pycnogenol acting as a direct ACE inhibitor although it can lower blood pressure in other ways.

Benefits

Atrial fibrillation benefit
Angiotensin-converting enzyme (ACE) inhibitors, angiotensin II-receptor blockers (ARBs), and beta-blockers are all superior to calcium channel blockers in reducing the risk of A fib. Compared with calcium channel blockers, each of these agents reduces the risk of this common arrhythmia by around 25% Dr. Christoph R. Meier, from University Hospital Basel, Switzerland, looked into this issue using the UK's General Practice Research Database of 680,000 patients with hypertension. The nested case-control analysis included patients between the ages of 20 and 79, and it excluded patients with risk factors for AF (history of any arrhythmia, congestive heart failure, ischemic and valvular heart disease, thyrotoxicosis, alcoholism, or chronic obstructive pulmonary disease). Ann Intern Med 2010 published the study done by Dr. Christoph R. Meier.

ACE Inhibitors and heart attack
Lisinopril, captopril, ramipril, and trandolapril are ace inhibitor drugs used in some patients after a heart attack. After a heart attack, some of the heart muscle is damaged and weakened. The heart muscle may continue to weaken as time goes by. This makes it more difficult for the cardiac chambers to pump blood.

CHF, congestive heart failure
ACE inhibitor drugs are used to treat congestive heart failure.

Heart surgery

Treatment with ACE inhibitors interferes with red blood cell formation and increases the risk of prolonged episodes of anemia after heart surgery. A study of 42 men with anemia after cardiac surgery was conducted at Istituto Maria Nascente Fondazione Don Carlo Gnocchi in Milan by Dr. Vittorino Ripamonti. Approximately nine days after surgery, patients were randomized to enalapril maleate or not. All patients received ferrous sulfate 325 mg plus standard post-cardiac surgical therapy, including beta-blockers and antiplatelet drugs if coronary artery disease was the setting, or diuretics and anticoagulants if it was valvular disease. At 16 days, patients receiving enalapril had peak hemoglobin levels lower and red blood cell counts lower than patients not receiving the ACE inhibitor. By 60 days after randomization, hemoglobin and RBC counts were moving toward normal in both groups, but remained lower in those on enalapril. "In the postoperative period, when a prompt erythropoietic response is crucial, the positive actions of (ACE inhibitors) may be counterbalanced by persistent anemia, thus leading to a slower functional recovery," Dr. Ripamonti and colleagues conclude. Chest 2006.

ACE Inhibitors and kidney disease
Captopril is used to treat kidney problems in some diabetic patients who use insulin to control their diabetes. Over time, these kidney problems may get worse. Captopril may help slow down the further worsening of kidney problems.

ACE inhibitor and diabetes, blood sugar
In one study, treatment with ACE inhibitors appeared to delay mortality in patients with diabetes who also have microalbuminuria (and pre-existing heart disease) or frank albuminuria. However, a 3 year study with the ace inhibitor ramipril did not show any benefit. For the time being, diet and exercise are better options for the delay of diabetic symptoms that the use of an ace inhibitor.

Aortic aneurysm

Treatment with an ACE inhibitor is associated with a decreased risk of rupture in patients with abdominal aortic aneurysm.
 

Types of ACE Inhibitor drugs available by prescription
Benazepril - Lotensin - is used to treat high blood pressure. It is sometimes combined with hctz. Cough is a common side effect which some patients assume is bronchitis.
Captopril - Capoten
Cilazapril
Enalapril - Vasotec
Fosinopril - Monopril -
Lisinopril - Prinivil or Zestril
Moexipril - Univasc
Perindopril
Quinapril - Accupril
Ramipril - Altace - Contrary to previous research suggesting that ramipril may check the progression to diabetes in pre-diabetics, 3-year results of a multinational, prospective trial failed to show that this ace inhibitor is superior to placebo in reducing the incidence of diabetes or death in a cohort of patients with impaired fasting glucose levels or impaired glucose tolerance. N Engl J Med 2006.
Perindopril - Aceon
Trandolapril - Mavik
 

ACE inhibitor side effects, caution, safety and risks, danger
Cough is a common ACE inhibitor side effect which can last several weeks after stopping the medication. The other most common side effects include headache, and dizziness. ACE inhibitors may sometimes cause elevated amounts of potassium in the blood. Your doctor can do blood tests to monitor your potassium levels. Rare adverse reactions include skin rash, kidney problems, and swelling of the face, lips, and throat.

A dry, irritating, nonproductive cough is a common ACE inhibitors side effect, Up to 40 percent of  those prescribed these medications may have annoying cough symptoms. Cough has been attributed to an increase in bradykinin and/or other vasoactive peptides, such as Substance P, which may play a second messenger role in setting off the cough reflex. If a patient placed on an ACE inhibitor has chronic cough, it may be a good idea to stop it and try another medicine for the condition being treated. Cough may seem like bronchitis and there is bronchospasm present.

The risk of angioedema -- localized swelling in the deep layers of the skin that usually affects the face, throat, lips or tongue -- is much more likely with angiotensin converting enzyme inhibitors than with other antihypertensive drugs.

There is still no agreement in the medical community as to whether ACE inhibitors lead to impotence or erectile dysfunction.

Pregnancy
Ace inhibitors were previously thought to be safe when taken early in pregnancy but now appear to raise the risk of major birth defects. Babies whose mothers took ACE inhibitors in their first trimester were more than twice as likely to be born with serious heart and brain problems than those not exposed to any pressure-lowering medicines. Other types of blood pressure drugs did not raise the risk to babies. About 10 percent of pregnant women develop high blood pressure, which can lead to a heart attack or stroke. A national survey found the number of ACE inhibitor prescriptions given to women of childbearing age increased from 1.4 million in 1995 to 2.7 million in 2002. ACE inhibitors already carry a strong Food and Drug Administration “black box” warning about their dangers in the later stages of pregnancy, and the label says the drugs should be discontinued when pregnancy is detected. But little has been known about their early effects.

Interactions with dietary supplements, herbal medications
Can an ace inhibitor be taken with glucosamine sulfate or cat's claw? What about with fish oils and krill oil supplements or a multivitamin pill?
   Not enough research has been done to determine the interaction between ace inhibitors and herbs and nutrients. However, glucosamine, used for osteoarthritis, is a safe supplement and can be used with most drugs. There is not as much information regarding cat's claw. One to three fish oil or krill oil supplements should not interfere with the function of ace inhibitors. In fact fish oils can lower blood pressure. A low dose multivitamin should be fine.