From the FDA Drug Label
CLINICAL PHARMACOLOGY 12. 1 Mechanism of Action Ramipril and ramiprilat inhibit ACE in human subjects and animals. The effect of ramipril on hypertension appears to result at least in part from inhibition of both tissue and circulating ACE activity, thereby reducing angiotensin II formation in tissue and plasma.
The best Angiotensin-Converting Enzyme Inhibitor (ACE-I) to use for the treatment of Hypertension (HTN) cannot be determined from the provided information, as it only discusses the mechanism of action and effects of ramipril, without comparing it to other ACE inhibitors 1.
From the Research
Lisinopril is the best Angiotensin-Converting Enzyme Inhibitor (ACE-I) to use for the treatment of Hypertension (HTN) due to its once-daily dosing, long duration of action, and extensive clinical experience, as supported by the most recent study 2.
Key Points
- Lisinopril is effective in lowering blood pressure in all grades of essential hypertension, with a typical dose range of 10-40 mg daily 3, 4, 5.
- The medication has a long duration of action, allowing for once-daily dosing, which enhances patient adherence and reduces the risk of drug-drug interactions 4, 2.
- Lisinopril has been shown to be at least as effective as other antihypertensive agents, including hydrochlorothiazide, atenolol, and metoprolol, in reducing blood pressure 3, 5.
- The medication is well-tolerated, with common side effects including dry cough, hypotension, and rarely angioedema 3, 4, 5.
- ACE inhibitors, including lisinopril, are particularly beneficial for patients with diabetes, heart failure, or chronic kidney disease, but should be avoided in pregnancy 3, 4, 5.
Dosage and Administration
- Start with a lower dose and titrate upward every 2-4 weeks until blood pressure goals are achieved.
- Monitor kidney function and potassium levels before initiation and within 1-2 weeks after starting therapy.
Alternative Options
- Ramipril (2.5-20 mg daily) is another excellent option with proven cardiovascular benefits, although it may require twice-daily dosing 2.
- If a cough develops, switching to an angiotensin receptor blocker (ARB) like losartan is recommended as these provide similar benefits without the cough side effect.