ACE Inhibitors Linked to Risk of Fatal Strokes for Patients with High Blood Pressure

Researchers urged patients to discuss potential side effects of ACE inhibitors with their doctors, and alternatives for treatment of hypertension, particularly if they have a history of stroke or heart disease.

Certain hypertension medications, such as Enalapril, Innovace and Lotensin, may increase a person’s risk of suffering a fatal stroke, according to the findings of a new study.

Researchers from the University of Texas warn that patients with high blood pressure face more than a 20% increased risk of fatal stroke if they take a class of hypertension medications, known as angiotensin-converting enzyme (ACE) inhibitors, compared to those who take diuretics. The findings were published on December 4 in the journal JAMA Network Open.

ACE inhibitors are a class of drug that helps open the veins and arteries to lower blood pressure. The medications work by preventing an enzyme in the body from making a substance that narrows blood vessels, which can cause high blood pressure.

Millions of people in the United States use ACE inhibitors to help control high blood pressure, which means a significant number of Americans may be susceptible to serious health side effects such as cancer, stroke, and other health problems.

ACE Inhibitor Stroke Risks

In this latest study, researchers examined outcomes for patients taking three types of hypertension medications, including thiazide-type diuretics, calcium channel blockers (CCBs) and ACE inhibitors. They looked at data from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), a multicenter randomized, double-blind, active-controlled clinical trial, involving nearly 33,000 participants.

The ALLHAT study followed patients 55 years and older diagnosed with hypertension and at least one other coronary heart disease factor for up to 23 years from 1994 to 2017. Researchers looked for death due to heart disease, stroke, heart failure, end-stage renal disease and cancer.

According to the findings, there was largely no difference in death rates or other side effects between the three groups. However, patients taking ACE inhibitors had a 19% increased risk of stroke death and an 11% increased risk of combined fatal and nonfatal hospitalized stroke.

Prior research has linked the use of ACE inhibitors like Lotensin, Prinivil, and Altace to an increased risk of lung cancer.

Similarly, a study published in 2021 linked ACE inhibitor use to an increased risk of suffering from schizophrenia. Researchers believe the drug targets certain genes and can increase the likelihood of the neurological condition.

Researchers emphasize the importance of doctors discussing both the benefits and risks of medications with patients before they begin to use them. In this case, they determined it is especially important for patients with a history of cardiovascular disease or stroke to discuss the risks and potential alternatives with their doctor.