ACE inhibitors

Inhibit angiotensin-converting enzyme: less angiotensin II and aldosterone, more bradykinin.

Members

RamiprilA long-acting ACE inhibitor with outcome evidence across the cardiovascular spectrum.PerindoprilA long-acting ACE inhibitor with a genuinely once-daily day.LisinoprilThe ACE inhibitor that needs no activation, which matters in liver failure.

Also in this class: Perindopril · Lisinopril (no hepatic activation needed) · Enalapril · Captopril (short-acting, historical). Full pages arrive as the library grows.

Compare the members

Drug	Prodrug	Effective half-life	Typical schedule
Ramipril	Yes (ramiprilat)	13-17 h	Once daily

Ramipril

Prodrug: Yes (ramiprilat)
Effective half-life: 13-17 h
Typical schedule: Once daily

Shared across the class

Indications: Hypertension · HFrEF · Post-MI · Proteinuric CKD · Vascular risk reduction
Adverse effects: Dry cough (bradykinin) · Hyperkalemia · Creatinine bump on initiation · Hypotension · Angioedema (rare, serious)
Contraindications: Pregnancy · Prior ACE-inhibitor angioedema · Bilateral renal artery stenosis
Monitoring: Creatinine and potassium 1-2 weeks after start or dose change · Blood pressure · Cough and angioedema symptoms

What makes each agent different

Most are prodrugs (ramipril, perindopril, enalapril); lisinopril and captopril are active as swallowed. Relevant in severe liver disease.
Duration: captopril needs multiple daily doses; ramipril and perindopril hold a day.
Practically, the class effects dwarf the differences: switching within the class rarely fixes an adverse effect.

The 30% creatinine rule: an expected bump is hemodynamic proof the drug is working on the efferent arteriole.

Last reviewed 2026-08-15 · Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed.