Are angiotensin-converting enzyme (ACE) inhibitors a common treatment for high blood pressure?

Angiotensin-converting enzyme (ACE) inhibitors are one of the most commonly prescribed class of antihypertensive in the US.^1,2 Lisinopril was the second most prescribed medication in the US in 2016 with 110 million prescriptions.² It was the most prescribed antihypertensive. The number of prescriptions grew every year from 2012 to 2016 by two to four million prescriptions a year.

In the US, overall use of ACE inhibitors as a monotherapy or as part of combination therapy for hypertension was 25.5% of all hypertensive therapies (1.2 standard error [SE]) in 2001 – 2002 and grew to 33.3% (1.1 SE, p_trend<0.01) in 2009 – 2010.¹ ACE inhibitors are the most common monotherapy antihypertensive agent for all of these years. Lisinopril was the most commonly used antihypertensive agent in 2009 – 2010 with a prevalence of 20.1% (1.5 SE, p_trend<0.01).

The 2017 hypertension guidelines³ from the American College of Cardiology and American Heart Association list ACE inhibitors as one of the four antihypertensive agents recommended for first-line treatment of hypertension. There are 12 classes of medication listed in the guideline.

References

1. Gu Q, Burt VL, Dillon CF, Yoon S. Trends in antihypertensive medication use and blood pressure control among United States adults with hypertension: the National Health And Nutrition Examination Survey, 2001 to 2010. Circulation 2012; 126 (17): 2105-2114.
2. Aitken M, Kleinrock M. Medicines Use and Spending in the U.S.: A Review of 2016 and Outlook to 2021. In: Parsippany, NJ: IQVIA Institute for Human Data Science; 2017: https://www.iqvia.com/-/media/iqvia/pdfs/institute-reports/medicines-use-and-spending-in-the-us.pdf.
3. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2017.