Last Updated on August 19, 2026
Ace Inhibitors (ACEIs)
Benefits
• Can lower cardiovascular risk
• Can prevent coronary artery disease in patients with HTN
• Can reduce mortality & morbidity in patients with congestive heart failure
• No adverse effect on lipid & glucose metabolism
Adverse effects
• Dry cough In patients with renovascular disease / renal impairment
• Angioedema (rare)
•
Deterioration of renal function
Doses
ACEi | Starting dose | Recommended maximum daily dose | Remark |
25 mg BD | 50 mg TDS | ||
10 mg OD | 40 mg OD | ||
Lisinopril | 10 mg OD | 80 mg OD | |
• 4 mg OD (as erbumine) | • 8 mg OD (as erbumine) | ||
Ramipril | 2.5 mg OD | 10 mg OD | |
Imidapril | 5 mg OD | 20 mg OD |
Precautions
• Check baseline
renal profile
focus on potassium & creatinine level • If ACEi started in hospital, remember to give a memo to patients to repeat RP within 2 weeks of initiation of ACEi in Klinik Kesihatan upon discharge • If hyperkalaemia (more than 5.6 mmol/L) or persistent increase of serum creatinine more than 30% from baseline within 2 months, reduce / discontinue ACEi dose
•
Re-check
Angiotensin Receptor Blockers (ARBs)
Benefits
• Persistent dry cough is
less
Therefore can be used to replace ACEI for patients intolerant to ACEi
Doses
ARB | Starting dose | Recommended maximum daily dose | Remark |
Candesartan | 8 mg OD | 32 mg OD | |
Irbesartan | 150 mg OD | 300 mg OD | |
50 mg OD | 100 mg OD | ||
40 mg OD | 80 mg OD | ||
80 mg OD | 320 mg OD | ||
Olmesartan | 20 mg OD | 40 mg OD |
Precautions
• Combination of ACEI and ARB is not recommended and is to be avoided