ACE inhibitor

ACE inhibitors are a class of blood-pressure medication (lisinopril, enalapril, ramipril) that work by blocking production of angiotensin II. Effective first-line for hypertension, heart failure, and chronic kidney disease in most adults.

The evidence base shows ACE inhibitors are LESS effective at lowering blood pressure in Black patients as monotherapy than in white patients (the ALLHAT trial documented this). Black hypertensive patients often respond better to thiazide diuretics or calcium-channel blockers as first-line. ACE inhibitors are still essential for Black patients with diabetes or heart failure, but the choice of first-line agent matters.