ACE Inhibitors

Angiotensin-converting enzyme inhibitors (ACEi)

Mechanism of Action

  • Relaxes tension in blood vessels
  • Can have a diuretic effect
  • Insufficient data documenting cardiac and renal protective effects, angiotensin-II receptor


  • High blood pressure (hypertension)
  • Congestive heart failure (left ventricular systolic dysfunction)
  • Acute myocardial infarction (heart attack)
  • Kidney complications of diabetes mellitus (diabetic nephropathy)


  • Captopril (Capoten)
  • Vasotec (Enalapril)
  • Enalapril (Vasotec, Renitec, Berlipril, Enap/Enalapril Profarma)
  • Ramipril (Altace, Prilace, Ramace,
  • Ramiwin, Triatec, Tritace)
  • Quinapril (Accupril)
  • Perindopril (Coversyl, Aceon, Perindo)
  • Lisinopril (Listril, Lopril, Novatec, Prinivil, Zestril, Lisidigal)
  • Benazepril (Lotensin)
  • Imidapril (Tanatril)
  • Trandolapril (Mavik, Odrik, Gopten)
  • Cilazapril (Inhibace)
  • Fosinopril (Fositen/Monopril)
  • Captopril (Capoten)
  • Zofenopril, Zoprace (Bifracard, Bifril, Bifrizide, CoTeoula, Presiam, Teoula, Zantipres, Zantiprid, Zantipride, Zofaril, Zofecard, Zofen, Zofenil, Zofenilduo, Zofenopril Mylan, Zofenoprilcalcium Mylan, Zofepril, Zofil, Zofipress, Zofistar, Zomen, Zopranol, Zoprazide, Zoprotec)

Effect on Rest and Exercise

  • Increase
    • Slight increase in heart rate (Niedfeldt 2002)
    • Increase in cardiac output (Niedfeldt 2002)
    • Increase in stroke volume (Niedfeldt 2002)
    • Increase in exercise tolerance in those with congestive heart failure (ACSM 2014)
    • Improve cognition of patients with heart failure (Dizon 2013)
      • associated with the blockage of AngII
  • Decrease
    • Decreased resting blood pressure (ACSM 2013)
    • Decreased blood pressure during exercises (ACSM 2013)
    • Decrease in vascular resistance (Niedfeldt 2002)
  • No Effect
    • No effect in plasma volume (Niedfeldt 2002)
    • No effect on heart rate (ACSM 2013)
    • No effect on cardiac output (ACSM 2013)
    • No effect on training
    • No effect on physical performance (ACSM 2013)
    • No effect on RPE
    • No effect on work capacity, RPE, lactate threshold, heart rate, maximum oxygen uptake, plasma levels of total cholesterol, triglycerides, free fatty acids, glucose, insulin, cortisol, and human growth hormone. (Predel 1994)

Potential Side Effects

  • Dry nonproductive cough (angiotensin I blockers) (Niedfeldt 2002)
    • 5%-35% of patients
  • Hypotension (low blood pressure),
  • Hyperkalemia (high blood potassium)
  • Headache
  • Dizziness
  • Fatigue
  • Nausea
  • Renal impairment
  • Increase inflammation-related pain
    • via increases of bradykinin

Recommended Populations

  • Physically active patients with hypertension (Predel 1994)
  • Patients with diabetes mellitus, renal insufficiency, congestive heart failure, asthma, or hyperlipidemia (Niedfeldt 2002)

Populations Not Recommended

  • Women who are not using contraception (Niedfeldt 2002)
  • Pregnant women
  • Patients with impaired renal function

Banned Status

  • None (Niedfeldt 2002)   


American College of Sports Medicine (2013). Guidelines for Exercise Testing and Prescription, William & Wilkins, 9, 401.

Dizon LA, Seo DY, Kim HK, Kim N, Kyung Soo Ko KS, Rhee BD, Han J (2013). Exercise perspective on common cardiac medications. Integrative Medicine Research; 2(2), 49-55.

Niedfeldt MW (2002). Managing Hypertension in Athletes and Physically Active Patients. Am Fam Physician. 1;66(3):445-453.

Predel HG, Rohden C, Heine O, Prinz U, Rost RE (1994). ACE inhibition and physical exercise: studies on physical work capacity, energy metabolism, and maximum oxygen uptake in well-trained, healthy subjects. J Cardiovasc Pharmacol. 23 Suppl 1:S25-8.

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