Examples of ACE Inhibitors and ARBs
ACE inhibitors and ARBs are two distinct classes of renin-angiotensin-aldosterone system (RAAS) blockers, each with multiple available agents that differ in dosing frequency and target doses.
ACE Inhibitors (Angiotensin-Converting Enzyme Inhibitors)
The following ACE inhibitors are commonly used in clinical practice 1, 2, 3:
Short-Acting ACE Inhibitors
Once or Twice Daily ACE Inhibitors
- Enalapril: Initial dose 2.5 mg twice daily, maximum 10-20 mg twice daily 1, 2, 3
- Lisinopril: Initial dose 2.5-5 mg once daily, maximum 20-40 mg once daily 1, 2, 3
- Ramipril: Initial dose 1.25-2.5 mg once daily, maximum 10 mg once daily 1, 2
- Fosinopril: Initial dose 5-10 mg once daily, maximum 40 mg once daily 1, 2, 3
- Quinapril: Initial dose 5 mg twice daily, maximum 20 mg twice daily 1, 2, 3
- Perindopril: Initial dose 2-4 mg once daily, maximum 8-16 mg once daily 1, 2, 3
- Trandolapril: Initial dose 1 mg once daily, maximum 4 mg once daily 1, 2, 3
- Benazepril: Initial dose 10 mg daily, maximum 20-40 mg daily in 1-2 divided doses 3
- Moexipril: Initial dose 7.5 mg daily, maximum 7.5-30 mg daily in 1-2 divided doses 3
Angiotensin Receptor Blockers (ARBs)
The following ARBs are commonly used in clinical practice 1, 2, 3:
- Candesartan: Initial dose 4-8 mg once daily, maximum 32 mg once daily 1, 2, 3
- Losartan: Initial dose 25-50 mg once daily, maximum 50-150 mg once daily 1, 2, 3
- Valsartan: Initial dose 20-40 mg twice daily, maximum 160 mg twice daily 1, 2, 3
- Irbesartan: Initial dose 150 mg daily, maximum 150-300 mg daily 3
- Telmisartan: Initial dose 40 mg daily, maximum 40-80 mg daily 3
- Olmesartan: Initial dose 20 mg daily, maximum 20-40 mg daily 3
- Eprosartan: Initial dose 600 mg daily, maximum 400-800 mg daily in 1-2 divided doses 3
Key Clinical Distinctions
ACE inhibitors remain the first-choice RAAS blocker for most cardiovascular indications, with ARBs serving as alternatives when ACE inhibitors are not tolerated 1, 4, 5. The primary reason for switching from an ACE inhibitor to an ARB is intolerable cough (occurring in up to 50% of Chinese patients and varying by ethnicity) or angioedema (occurring in <1% but more frequent in Black patients) 1.
The combination of an ACE inhibitor with an ARB is not recommended, as trials have demonstrated increased adverse events including renal dysfunction, hyperkalemia, and hypotension without mortality benefit 1, 6, 7.