ACE inhibitors suppress conversion of angiotensin I to angiotensin II and reduce degradation of bradykinin.

Reduced angiotensin II lowers vasoconstriction and aldosterone signalling. Efferent arteriolar dilation can reduce intraglomerular pressure.

Common members include captopril, enalapril, lisinopril, ramipril and perindopril.

Common class roles include hypertension, heart failure with reduced ejection fraction, selected post-myocardial-infarction care and proteinuric chronic kidney disease, according to patient-specific guidance.

Cough, hyperkalaemia, hypotension, a rise in creatinine and rare angioedema are class-defining concerns.

Avoid in pregnancy and in prior ACE-inhibitor angioedema. Dual RAAS blockade increases risk; neprilysin-inhibitor transitions require the recommended washout interval.