Compound Physician required

ACE Inhibitor or ARB

First-line blood-pressure medication. Bonus protection for kidneys.

Approved Verified 27 August 2026

What it does

The default starting point when blood pressure stays above target after lifestyle effort. The evidence base is enormous, the cost is low, and the side-effect profile is mild for most patients — with added kidney protection in diabetes or early kidney disease.

Both classes interrupt the renin-angiotensin-aldosterone system — ACE inhibitors block angiotensin II formation, ARBs block its receptor. The result is vasodilation and reduced sodium and water retention.

  • blood pressure
  • kidney protection

What the evidence shows

Overall evidence strength: High certainty

Who it's for, who should skip

Blood pressure persistently above 130/80 despite lifestyle effort. ACE inhibitors and ARBs are interchangeable for most — the choice is about tolerability (ACE inhibitors more often cause cough).

Skip it if

  • pregnancy — Contraindicated in pregnancy. hard block

Running it

Form
oral
Dose
daily
Titration
titrated to blood-pressure target

Safety

  • ACE-inhibitor cough (~10%) common
  • hyperkalemia uncommon
  • angioedema rare

Stacking & alternatives

Access & cost

Prescription or clinician order — typically via primary care or cardiology.

Last reviewed 27 August 2026. Regulatory status verified 27 August 2026.