ACE Inhibitors: How They Lower Blood Pressure and Protect Your Heart

When your blood pressure stays too high, it strains your heart, damages your arteries, and puts extra stress on your kidneys. ACE inhibitors, a class of medications that block the angiotensin-converting enzyme to relax blood vessels and reduce fluid retention. Also known as angiotensin-converting enzyme inhibitors, they’re one of the most prescribed treatments for hypertension, heart failure, and kidney disease in people with diabetes. These drugs don’t just lower numbers on a meter—they help your body heal by reducing the harmful stress hormones that build up when your cardiovascular system is overworked.

ACE inhibitors work by stopping the body from turning angiotensin I into angiotensin II, a powerful chemical that narrows blood vessels and tells your kidneys to hold onto salt and water. By blocking this process, your blood vessels relax, your heart doesn’t have to pump as hard, and excess fluid leaves your system. This is why they’re often used after a heart attack—to ease the burden on a weakened heart. They’re also a top choice for people with diabetic kidney disease because they slow down damage to the tiny filters in the kidneys, something few other drugs can do as effectively.

Related to ACE inhibitors are other blood pressure drugs like angiotensin receptor blockers (ARBs), which block the same hormone but at a different point in the pathway. While ARBs work similarly, ACE inhibitors are often tried first because they’ve been used longer and have more real-world data showing long-term benefits. But they’re not for everyone. A dry cough is a common side effect—so if you start one and can’t stop coughing, your doctor might switch you. You’ll also need blood tests to check your kidney function and potassium levels, since these drugs can raise potassium too high, especially if you’re on a salt substitute or take certain supplements.

People with heart failure, after a heart attack, or with chronic kidney disease often stay on ACE inhibitors for years, sometimes for life. They’re not a quick fix—they’re part of a longer-term strategy to keep your heart and kidneys working well. And while newer drugs like SGLT2 inhibitors are gaining attention for heart and kidney protection, ACE inhibitors still hold a strong place in guidelines because they’ve been tested in millions of patients over decades.

Below you’ll find real-world guides on how these drugs fit into daily life—from managing side effects to understanding how they interact with other medications like statins or diuretics. You’ll also see how they compare with alternatives, what to watch for, and how doctors decide who gets them and why. This isn’t just about taking a pill—it’s about protecting your body’s most vital systems, one dose at a time.