ACE Inhibitors and Nifedipine Can Be Given Together
Yes, ACE inhibitors and nifedipine can be safely and effectively combined for hypertension management, and this is actually a preferred combination strategy supported by major international guidelines. 1
Guideline Support for This Combination
The 2013 ESH/ESC Guidelines explicitly identify ACE inhibitor plus calcium antagonist (including nifedipine, a dihydropyridine) as a preferred combination represented by green continuous lines in their combination algorithm. 1 This combination is recommended for:
- Initial dual therapy in most hypertensive patients 1
- Fixed-dose single-pill combinations to improve adherence 1
- Triple therapy regimens (ACE inhibitor + calcium antagonist + diuretic) when blood pressure remains uncontrolled 1
The 2007 ESH/ESC Guidelines similarly list "calcium antagonist and ACE inhibitor" among effective and well-tolerated two-drug combinations. 1
Clinical Evidence and Mechanisms
The combination works through complementary mechanisms:
- ACE inhibitors block the renin-angiotensin system 1
- Nifedipine provides vasodilation through calcium channel blockade 1
- This dual approach achieves additive blood pressure reduction 1
Research demonstrates that lisinopril combined with nifedipine GITS produces significantly greater blood pressure reduction (P < 0.001) compared to either drug alone, with improved 24-hour blood pressure control homogeneity. 2 A multicenter study of perindopril plus nifedipine showed effective blood pressure reduction (-12.1/-10.8 mmHg) with similar tolerability to other combinations. 3
Important Safety Considerations
Use long-acting nifedipine formulations only. Short-acting nifedipine capsules should never be prescribed due to severe hemodynamic instability risk. 1 The 1999 British Hypertension Society Guidelines explicitly state "nifedipine in capsule form should no longer be prescribed." 1
Monitor for hypotension, particularly when:
- Initiating combination therapy 1
- Treating patients with left ventricular dysfunction (use with great caution) 1
- Adding to existing antihypertensive regimens 4
The FDA label notes that benazepril co-administered with nifedipine showed no significant pharmacokinetic interactions, though a hypotensive effect was observed with combination therapy. 4
Contraindicated Combinations to Avoid
Never combine two RAS blockers (ACE inhibitor + ARB, or either with renin inhibitor). The ONTARGET and ALTITUDE trials demonstrated increased risk of end-stage renal disease and stroke with dual RAS blockade. 1 This is the only combination that guidelines explicitly recommend against—not ACE inhibitor plus calcium antagonist. 1
Practical Implementation
Start with standard doses and monitor blood pressure response within 2 months. 1 Consider fixed-dose combinations to improve adherence. 1 The combination is particularly useful when: