Altace (ramipril) is an angiotensin-converting enzyme (ACE) inhibitor prescription medication clinically proven to manage hypertension and reduce cardiovascular risk. This first-line antihypertensive agent works by relaxing blood vessels, allowing blood to flow more smoothly and the heart to pump more efficiently. It is indicated not only for hypertension management but also for post-heart attack care and risk reduction in high-risk patients. With its well-established efficacy profile and extensive clinical validation, Altace remains a cornerstone therapy in cardiovascular protection strategies under appropriate medical supervision.

Features

• Active ingredient: Ramipril (2.5 mg, 5 mg, 10 mg capsules)
• Drug class: Angiotensin-converting enzyme (ACE) inhibitor
• Administration: Oral capsule, once or twice daily dosing
• Bioavailability: 50–60% (not significantly affected by food)
• Half-life: 13–17 hours (ramiprilat active metabolite)
• Excretion: Primarily renal (60%) with some fecal elimination

Benefits

• Significant blood pressure reduction: Effectively lowers both systolic and diastolic blood pressure through RAAS inhibition
• Cardiovascular risk reduction: Demonstrated to decrease mortality and morbidity in patients with heart failure post-myocardial infarction
• Renoprotective effects: Slows progression of diabetic nephropathy and reduces proteinuria in diabetic patients
• Vascular protection: Improves endothelial function and reduces arterial stiffness
• Flexible dosing: Allows for individualized titration based on therapeutic response and tolerability
• Well-established safety profile: Decades of clinical use with comprehensive understanding of adverse effect management

Common use

Altace is primarily prescribed for the treatment of hypertension (high blood pressure) in adults. It is also FDA-approved for reducing the risk of heart attack, stroke, or death from cardiovascular causes in patients 55 years or older who are at high risk for these events due to a history of coronary artery disease, stroke, or peripheral vascular disease. Additionally, Altace is used in the management of heart failure following a heart attack and for reducing the risk of death from cardiovascular causes after acute myocardial infarction. Off-label uses may include diabetic nephropathy management and chronic kidney disease progression delay, though these should only be undertaken under specialist supervision.

Dosage and direction

The recommended initial dosage for hypertension is 2.5 mg once daily. Dosage may be adjusted based on blood pressure response at intervals of about 2 weeks, with a usual maintenance dose of 2.5–20 mg per day administered as a single dose or in two equally divided doses. For cardiovascular risk reduction, the initial dose is 2.5 mg once daily for one week, followed by 5 mg once daily for the next three weeks, then increased as tolerated to 10 mg once daily. For post-myocardial infarction heart failure, initiate with 2.5 mg twice daily and titrate upward as tolerated. Capsules should be swallowed whole with a glass of water, with or without food, at approximately the same time each day to maintain consistent blood levels.

Precautions

Patients should be monitored for hypotension, especially during initial titration and in volume-depleted patients. Regular assessment of renal function and serum potassium is essential, particularly in patients with renal impairment, diabetes, or those taking potassium supplements or potassium-sparing diuretics. Angioedema may occur at any time during treatment, requiring immediate discontinuation and appropriate management. Neutropenia/agranulocytosis has been reported with ACE inhibitors; monitor white blood cell counts in patients with collagen vascular disease or renal impairment. Use with caution in patients with aortic stenosis or hypertrophic cardiomyopathy. Pregnancy should be avoided during treatment due to potential fetal harm. Surgical anesthesia may require dosage adjustment due to potential hypotension.

Contraindications

Altace is contraindicated in patients with a history of angioedema related to previous ACE inhibitor treatment. It is also contraindicated in patients with hereditary or idiopathic angioedema. Concomitant use with aliskiren-containing products is contraindicated in patients with diabetes. The medication is contraindicated during pregnancy due to risk of fetal injury and death. Hypersensitivity to ramipril or any component of the formulation, or hypersensitivity to other ACE inhibitors, represents an absolute contraindication.

Possible side effect

Common adverse reactions (≥1%) include: persistent dry cough (up to 12% of patients), dizziness (2–12%), headache (2–5%), fatigue (2–3%), nausea/vomiting (1–2%), and chest pain (1–2%). Less frequent but serious side effects may include: angioedema (0.1–0.5%), hypotension (0.5–1%), hyperkalemia (2–5%), renal impairment (1–2%), and neutropenia/agranulocytosis (rare). Other reported effects include orthostatic hypotension, rash, impotence, dysgeusia (taste disturbance), and pancreatitis. Most side effects are dose-dependent and may diminish with continued therapy or dosage adjustment.

Drug interaction

Significant interactions occur with: potassium supplements, potassium-sparing diuretics, and salt substitutes (increased risk of hyperkalemia); diuretics (potentiated hypotensive effect); NSAIDs (may reduce antihypertensive effect and increase renal impairment risk); lithium (increased lithium levels and toxicity risk); gold injections (nitritoid reactions); aliskiren (increased risk of renal impairment, hyperkalemia, and hypotension); and mTOR inhibitors (increased risk of angioedema). Dual blockade of the renin-angiotensin system with ARBs or renin inhibitors increases risks of hypotension, hyperkalemia, and renal impairment.

Missed dose

If a dose is missed, it should be taken as soon as possible on the same day. However, if it is nearly time for the next scheduled dose, the missed dose should be skipped and the regular dosing schedule resumed. Patients should never take a double dose to make up for a missed one. Consistent daily administration is important for maintaining stable blood pressure control. Setting daily reminders or associating dosing with routine activities (such as tooth brushing) can help improve adherence.

Overdose

Symptoms of overdose may include pronounced hypotension, circulatory shock, bradycardia, electrolyte disturbances, and renal failure. Management involves supportive measures including intravenous normal saline for volume expansion. Ramipril is not effectively removed by hemodialysis due to high protein binding. Bradycardia may require atropine administration. ACE inhibitor overdose requires intensive monitoring of blood pressure, heart rate, and renal function. Angiotensin II infusion may be considered in severe cases unresponsive to volume expansion.

Storage

Store Altace capsules at controlled room temperature (20–25°C or 68–77°F) with excursions permitted between 15–30°C (59–86°F). Keep the container tightly closed and protect from moisture and light. Do not store in bathroom cabinets where humidity levels fluctuate. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging. Proper disposal of unused medication should follow local regulations, typically through medication take-back programs.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Altace is a prescription medication that should only be used under the supervision of a qualified healthcare professional. Individual response to medication may vary, and only your physician can determine the appropriate treatment based on your specific medical condition, history, and current medications. Never initiate, discontinue, or change dosage without consulting your healthcare provider. Report any adverse effects or concerns to your physician promptly.

Reviews

Clinical studies consistently demonstrate Altace’s efficacy in blood pressure management and cardiovascular risk reduction. The HOPE study showed a 22% reduction in the composite endpoint of myocardial infarction, stroke, or cardiovascular death in high-risk patients. Physicians report reliable antihypertensive effects with once-daily dosing in many patients. Patient reviews frequently note effective blood pressure control but mention the characteristic ACE inhibitor cough as a common reason for discontinuation. Many long-term users appreciate the cardiovascular protective benefits beyond blood pressure reduction. Adherence is generally good with the once-daily formulation, though some patients require divided dosing for 24-hour coverage.