Editing ACE inhibitor (section)

==Comparative information==
All ACE inhibitors have similar antihypertensive efficacy when equivalent doses are administered. The main differences lie with [[captopril]], the first ACE inhibitor. Captopril has a shorter duration of action and an increased incidence of adverse effects. It is also capable of passing through the [[blood–brain barrier]].<ref>{{cite journal | vauthors = Ho JK, Moriarty F, Manly JJ, Larson EB, Evans DA, Rajan KB, Hudak EM, Hassan L, Liu E, Sato N, Hasebe N, Laurin D, Carmichael PH, Nation DA | title = Blood-Brain Barrier Crossing Renin-Angiotensin Drugs and Cognition in the Elderly: A Meta-Analysis | journal = Hypertension | volume = 78 | issue = 3 | pages = 629–643 | date = September 2021 | pmid = 34148364 | pmc = 9009861 | doi = 10.1161/HYPERTENSIONAHA.121.17049 }}</ref><ref>{{cite journal | vauthors = Glodzik L, Santisteban MM | title = Blood-Brain Barrier Crossing Renin-Angiotensin System Drugs: Considerations for Dementia and Cognitive Decline | journal = Hypertension | volume = 78 | issue = 3 | pages = 644–646 | date = September 2021 | pmid = 34379433 | pmc = 9125564 | doi = 10.1161/HYPERTENSIONAHA.121.17595 }}</ref>

In a large clinical study, one of the agents in the ACE inhibitor class, [[ramipril]] (Altace), demonstrated an ability to reduce the mortality rates of patients with a [[myocardial infarction]] and to slow the subsequent development of heart failure. This finding was made after it was discovered that regular use of ramipril reduced mortality rates even in test subjects who did not have hypertension.<ref>{{Cite web|url=https://www.medscape.org/viewarticle/430926|title=Controversies in Cardiology II|website=Medscape}}</ref>

Some believe ramipril's additional benefits may be shared by some or all drugs in the ACE-inhibitor class. However, ramipril currently remains the only ACE inhibitor for which such effects are actually evidence-based.<ref>{{cite journal | vauthors = Ball SG, etal | collaboration = The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators | title = Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators | journal = Lancet | volume = 342 | issue = 8875 | pages = 821–828 | date = October 1993 | pmid = 8104270 | doi = 10.1016/0140-6736(93)92693-N | s2cid = 5770772 }}</ref>

A meta-analysis confirmed that ACE inhibitors are effective and certainly the first-line choice in hypertension treatment. This meta-analysis was based on 20 trials and a cohort of 158,998 patients, of whom 91% were hypertensive. ACE inhibitors were used as the active treatment in seven trials (n=76,615) and angiotensin receptor blocker (ARB) in 13 trials (n=82,383).
ACE inhibitors were associated with a statistically significant 10% mortality reduction: (HR 0.90; 95% CI, 0.84–0.97; P=0.004). In contrast, no significant mortality reduction was observed with ARB treatment (HR 0.99; 95% CI, 0.94–1.04; P=0.683). Analysis of mortality reduction by different ACE inhibitors showed that perindopril-based regimens are associated with a statistically significant 13% all-cause mortality reduction.
Taking into account the broad spectrum of the hypertensive population, one might expect that an effective treatment with ACE inhibitors, in particular with [[perindopril]], would result in an important gain of lives saved.<ref>{{cite journal | vauthors = van Vark LC, Bertrand M, Akkerhuis KM, Brugts JJ, Fox K, Mourad JJ, Boersma E | title = Angiotensin-converting enzyme inhibitors reduce mortality in hypertension: a meta-analysis of randomized clinical trials of renin-angiotensin-aldosterone system inhibitors involving 158,998 patients | journal = European Heart Journal | volume = 33 | issue = 16 | pages = 2088–2097 | date = August 2012 | pmid = 22511654 | pmc = 3418510 | doi = 10.1093/eurheartj/ehs075 }}</ref>

===Equivalent doses in hypertension===
The ACE inhibitors have different strengths with different starting dosages. Dosage should be adjusted according to the clinical response.<ref>[http://www.tripanswers.org/answer.aspx?criteria=&tagtrail=%2fACE+Inhibitors%2fdose+equivalence%2fCardiovascular+disease%2f&qid=3447&src=0 What are the dose comparisons of all ACE inhibitors used in hypertension?] {{Webarchive|url=https://web.archive.org/web/20150402093937/http://www.tripanswers.org/answer.aspx?criteria=&tagtrail=%2fACE+Inhibitors%2fdose+equivalence%2fCardiovascular+disease%2f&qid=3447&src=0 |date=2015-04-02 }} TripAnswers, [[Trip (search engine)|Trip]], May 25, 2007. Accessed 2009-11-21</ref><ref>Common Medication Conversions (Equivalents): [https://globalrph.com/medcalcs/drug-comparisons-ace-inhibitors-medication-equivalents/ Ace Inhibitors] {{Webarchive|url=https://web.archive.org/web/20150317170410/http://www.globalrph.com/aceinh.cgi |date=2015-03-17 }}. GlobalRPh.com. Accessed 2009-11-22.</ref><ref>[http://www.consumerreports.org/health/best-buy-drugs/ace-inhibitors.htm Treating High Blood Pressure and Heart Disease: the ACE Inhibitors]. Consumer Reports Health Best Buy Drugs. June 2009.</ref>
{| class=wikitable
|-
!colspan=6 | ACE inhibitors dosages for hypertension
|-
!colspan=2| ||| ||colspan=3 |Dosage
|-
|colspan=6 | Note: [[Bis in die|bid]] = two times a day, [[Ter in die|tid]] = three times a day, d = daily <br>Drug dosages from Drug Lookup, [https://online.epocrates.com/ Epocrates Online].
|-
! Name || Equivalent daily dose ||| || Start || Usual || Maximum
|-
| Benazepril || 10&nbsp;mg||| || 10&nbsp;mg || 20–40&nbsp;mg || 80&nbsp;mg
|-
| Captopril || 50&nbsp;mg (25&nbsp;mg bid) ||| || 12.5–25&nbsp;mg bid-tid || 25–50&nbsp;mg bid-tid || 150&nbsp;mg/d
|-
| Enalapril || 5&nbsp;mg ||| || 5&nbsp;mg || 10–40&nbsp;mg || 40&nbsp;mg
|-
| Fosinopril || 10&nbsp;mg || ||| 10&nbsp;mg || 20–40&nbsp;mg || 80&nbsp;mg
|-
| Lisinopril || 10&nbsp;mg || ||| 10&nbsp;mg || 10–40&nbsp;mg || 80&nbsp;mg
|-
| Moexipril || 7.5&nbsp;mg || ||| 7.5&nbsp;mg || 7.5–30&nbsp;mg || 30&nbsp;mg
|-
| Perindopril || 4&nbsp;mg ||| || 4&nbsp;mg || 4–8&nbsp;mg || 16&nbsp;mg
|-
| Quinapril || 10&nbsp;mg || ||| 10&nbsp;mg || 20–80&nbsp;mg || 80&nbsp;mg
|-
| Ramipril || 2.5&nbsp;mg || ||| 2.5&nbsp;mg || 2.5–20&nbsp;mg || 20&nbsp;mg
|-
| Trandolapril || 2&nbsp;mg || ||| 1&nbsp;mg || 2–4&nbsp;mg || 8&nbsp;mg
|- Imidapril || 5&nbsp;mg || ||| 5&nbsp;mg || 10&nbsp;mg ||20&nbsp;mg
|}