Side effects of ACE inhibitors


ACE inhibitors are a group of drugs that belong to the antihypertensives (blood pressure lowering drugs).

What exactly are the side effects?

When taking an ACE inhibitor, the following side effects may occur:

  • Headache
  • Nausea
  • Vomiting
  • Dizziness
  • Nervousness
  • Depression
  • Diarrhoea (diarrhoea)
  • Constipation (constipation)
  • Bronchitis
  • Excessive drop in blood pressure (hypotension)
  • Taste sensations
  • Liver damage

Important side effects

Dsypnoea I.e. shortness of breath, difficulty in breathing, shortness of breath Tinnitus These are constant or occasional or even increasing noises in the ear. Alopecia Increased hair loss leads to bald spots on the head.

Pruritus Compulsive scratching due to very itchy skin. Agina pectoris Strong feeling of tightness in the chest, often in combination with heart tightness and chest pain. You can also find out more about angina pectoris under our topic: Angina pectoris tachycardia (tachycardia of the heart) Spontaneous and self-induced tachycardia of the heart More information on tachycardia of the heart can also be found under our topic: Tachycardia Exanthema Inflammatory skin rash occurring over a large area Hyperkalemia High potassium levels in the blood Leukopenia A reduction in the number of white blood cells (leukocytes) in the blood Proteinuria Increased excretion of proteins in the urine Dry cough In 5-15% of the patients treated, a dry cough occurs as a result of inhibition of the breakdown of kinines. Kinins are hormones in the tissue that can promote the development of edema. The inhibition of the breakdown of kinines in the bronchial mucosa leads to a dry cough, which is only clinically relevant in 5% of cases.

Cough/coughing up

Dry cough and irritable cough are the most common side effects that can occur when taking ACE inhibitors. About five to ten percent of patients experience very pronounced symptoms. However, even up to 30 percent of those taking ACE inhibitors complain of at least a slight cough.

The side effect is that the breakdown of the tissue messenger substance bradykinin is inhibited. This mediates the cough stimulus in the lungs and also constricts the bronchial tubes. If the irritating cough causes too much discomfort, the ACE inhibitor must be discontinued in consultation with the doctor who prescribed the medication.

Another preparation with a different active substance must then be taken to lower the blood pressure. The so-called angiotensin-1 antagonists (Sartane) are often an alternative. The mechanism of action with regard to lowering blood pressure is very similar to that of ACE inhibitors, but there is no reduced breakdown of bradykinin and thus no irritable cough.


Tinnitus is a rare but possible side effect that can occur when taking ACE inhibitors. If you experience ringing in the ears after starting treatment with the antihypertensive drug, you should consult the doctor who prescribed the drug. If necessary, it should be discontinued or replaced by another. However, tinnitus can have many different causes and it may also be a coincidence if the symptom occurs while taking ACE inhibitors.