Background

ACE inhibitors (ACEIs) are used by tens of millions of Americans to treat high blood pressure and heart failure, to prevent repeat heart attacks, and to prevent the decline of kidney function in people with high blood pressure and/or diabetes. The monthly cost for ACEIs varies from less than $10 to more than $100. This report gives you information that could save you hundreds of dollars a year if you are currently taking a brand-name ACEI.

To help you and your doctor choose the right ACE inhibitor if you need one, Consumer Reports Best Buy Drugs has evaluated the drugs in this category based on their effectiveness, safety, and cost. This brief is a summary of a 19-page report you can access for free on the Internet at CRBestBuyDrugs.org. This Web site also has free reports about other drugs we’ve analyzed.

Our independent evaluations are based on scientific reviews conducted by the Oregon Health and Science University-based Drug Effectiveness Review Project. Grants from the Engelberg Foundation and the National Library of Medicine help fund Consumer Reports Best Buy Drugs. These materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multi-state settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

Do You Need an ACE Inhibitor?

The ACEIs can lower blood pressure. But we recommend starting with a diuretic medication as the initial “first-step” treatment for most people with high blood pressure who do not have heart disease, diabetes, or kidney disease because there is stronger evidence for diuretics that they prevent premature death and heart disease, stroke, and other cardiovascular problems. If you are unable to tolerate a diuretic or it does not lower your blood pressure enough, then it may be time to consider an ACEI.

ACEIs are a first option if you have heart failure with or without high blood pressure. They are also a first option to treat people after a heart attack, as well as people with diabetes (with and without kidney disease). The table below gives you general guidance on blood pressure levels and treatment.

Our Recommendations

ACEIs are effective, life-saving medicines that are generally considered safe. They help lower the risk of both fatal and nonfatal heart attacks and strokes, and kidney failure. And they improve quality of life.

We have selected the following five ACEIs as Consumer Reports Best Buy Drugs based primarily on the evidence for their effectiveness, but also on dosing convenience and cost in treating the following conditions:

All of these medicines are low-cost or moderately priced generics. All have been proven to be just as effective or superior to other ACEIs in treating the general population.

ACE inhibitors are generally safe medicines, but they can cause side effects, including a persistent dry cough, fatigue, weakness, dizziness, and potassium imbalance. They can also cause a rare but life-threatening swelling of the windpipe. You can often minimize side effects by taking the lowest dose that is effective for you.

This information was released and last updated in March 2011.

Blood Pressure Treatment Guidance

Blood Pressure Classification

Systolic Measure (mm Hg)

Diastolic Measure (mm Hg)

General Treatment Guidance

Normal

Below 120

Below 80

  • No treatment needed
  • Healthy lifestyle encouraged to maintain normal blood pressure

Prehypertensive

120–139

80–89

  • Lifestyle changes needed: weight loss, quitting smoking, low-salt and low-fat diet, curb excessive alcohol use, and increased exercise
  • Drug treatment not indicated except if you have diabetes or kidney or heart disease

Stage 1 High Blood Pressure

140–159

90–99

  • Lifestyle changes urged, same as above
  • Drug treatment needed. Doctor may start with one medicine (usually a diuretic) to see if it works

Stage 2 High Blood Pressure

160 or above

100 or above

  • Contact your doctor immediately
  • Drug treatment needed. Two or more medicines usually required to bring blood pressure down
  • Lifestyle changes, as described above, are a critical component of your treatment

Source: Chobanian AV, Bakris GL, Black HR, et al., “The seventh report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure,” Journal of the American Medical Association, 2003; 289(19):2560-2572

Cost Comparison

Generic Name, Dosage Strength, and Form1

Brand Name2

Frequency of Use (per day)

Total Daily Dose

Average Monthly Cost3

Best Buy Indication

Benazepril 10 mg tablet

Lotensin

One

10 mg

$76

Benazepril 10 mg tablet

Generic

One

10 mg

$8

High blood pressure, for people with kidney disease

Benazepril 20 mg tablet

Lotensin

One

20 mg

$69

Benazepril 20 mg tablet

Generic

One

20 mg

$8*

High blood pressure, for people with kidney disease

Benazepril 40 mg tablet

Lotensin

One

40 mg

$69

Benazepril 40 mg tablet

Generic

One

40 mg

$7*

High blood pressure, for people with kidney disease

Captopril 12.5 mg tablet

Generic

Three

37.5 mg

$21*

Heart failure

Captopril 25 mg tablet

Generic

Three

75 mg

$19*

Heart failure

Captopril 50 mg tablet

Generic

Three

150 mg

$57*

Heart failure

Captopril 100 mg tablet

Generic

Three

300 mg

$54*

Heart failure

Enalapril 5 mg tablet

Vasotec

One

5 mg

$91

Enalapril 5 mg tablet

Generic

One

5 mg

$8*

High blood pressure, heart failure

Enalapril 10 mg tablet

Vasotec

One

10 mg

$96

Enalapril 10 mg tablet

Generic

One

10 mg

$8*

High blood pressure, heart failure

Enalapril 20 mg tablet

Vasotec

One

20 mg

$134

Enalapril 20 mg tablet

Generic

One

20 mg

$15*

High blood pressure, heart failure

Lisinopril 5 mg tablet

Prinivil

One

5 mg

$41

Lisinopril 5 mg tablet

Generic

One

5 mg

$7*

Heart attack, high blood pressure

Lisinopril 10 mg tablet

Prinivil

One

10 mg

$46

Lisinopril 10 mg tablet

Generic

One

10 mg

$6*

Heart attack, high blood pressure

Lisinopril 20 mg tablet

Prinivil

One

20 mg

$48

Lisinopril 20 mg tablet

Generic

One

20 mg

$7*

Heart attack, high blood pressure

Lisinopril 30 mg tablet

Generic

One

30 mg

$18*

Heart attack, high blood pressure

Lisinopril 40 mg tablet

Zestril

One

40 mg

$85

Lisinopril 40 mg tablet

Generic

One

40 mg

$17*

Heart attack, high blood pressure

Perindopril 4 mg tablet

Generic

One

4 mg

$54

Ramipril 1.25 mg capsule

Generic

One

1.25 mg

$36

For people with diabetes or kidney disease

Ramipril 2.5 mg capsule

Altace

One

2.5 mg

$87

Ramipril 2.5 mg capsule

Generic

One

2.5 mg

$36

For people with diabetes or kidney disease

Ramipril 5 mg capsule

Altace

One

5 mg

$90

Ramipril 5 mg capsule

Generic

One

5 mg

$36

For people with diabetes or kidney disease

Ramipril 10 mg capsule

Altace

One

10 mg

$101

Ramipril 10 mg capsule

Generic

One

10 mg

$39

For people with diabetes or kidney disease

Trandolapril 2 mg tablet

Mavik

One

2 mg

$52

Trandolapril 2 mg tablet

Generic

One

2 mg

$35*

*Indicates the dose of that drug may be available for a low monthly cost through programs offered by chain stores. For example, Kroger, Sam’s Club, Target, and Walmart offer a month’s supply of selected generic drugs for $4 or a three-month supply for $10. Other stores, such as Costco, CVS, Kmart, and Walgreens, offer similar programs. Some programs have restrictions or membership fees, so check the details carefully for restrictions and to make sure your drug is covered.

1. Selected drugs and dosages only. For a complete price list of ACE inhibitors, go to CRBestBuyDrugs.org to download the free, full 19-page report.

2. “Generic” indicates that this drug is sold under its generic name. For example, in this table, the first drug listed is available as both generic benazepril and as brand-name Lotensin. Both have the same active ingredient. When column 2 says “generic,” the price listed is for the generic version at the specified dose.

3. Prices reflect nationwide retail average for January 2011, rounded to the nearest dollar. Information derived by Consumer Reports Best Buy Drugs from data provided by Symphony Health Solutions, which is not involved in our analysis or recommendations.

NOTE: The information contained in the Consumer Reports Best Buy Drugs™ reports is for general informational purposes and is not intended to replace consultation with a physician or other health-care professional. Consumers Union is not liable for any loss or injury related to your use of the reports. The reports are intended solely for individual, noncommercial use and may not be used in advertising, promotion, or for any other commercial purpose.


Copyright 2010, Consumers Union of United States, Inc

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