Ramipril
Prescription ·Exploratory record · not publication-reviewed ·Updated July 13, 2026
Ramipril is an ACE inhibitor with strong evidence from the HOPE trial showing cardiovascular risk reduction in high-risk patients without heart failure or low ejection fraction. It is used for hypertension, heart failure, and cardiovascular risk reduction in patients at high risk.
Exploratory record, not a reviewed medical publication.
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This generated database record has not completed a claim-level review by a qualified human medical reviewer. Bibliography links and evidence labels are not approval. The page remains available for reference and is excluded from search indexing.
What the research says.
A quick, data-only summary. The full evidence, dosing, and sources are below.
Ramipril is an ACE inhibitor with strong evidence from the HOPE trial showing cardiovascular risk reduction in high-risk patients without heart failure or low ejection fraction. NutriStack rates the supporting evidence as strong. Common adult dosing is 1.25–20 mg daily in 1–2 divided doses (as prescribed by your physician), though a prescriber sets the actual dose. With long-term use it can deplete zinc. This profile indexes 10 sources.
The bottom line
Evidence rating strong. Most-documented uses: reduces cardiovascular death, mi, and stroke in high-risk patients (hope trial), lowers blood pressure, reduces heart failure progression. 10 sources indexed (1996–2025), with 0 interaction records on file.
How it works, mechanistically.
Core mechanism
Prodrug converted in the liver to the active metabolite ramiprilat, a potent ACE inhibitor. Blocks conversion of angiotensin I to angiotensin II, reducing vasoconstriction, aldosterone release, and sympathetic activity. Enhances bradykinin-mediated vasodilation and has endothelial protective effects.
Dosing & protocol.
Can be taken with or without food; capsule can be opened and sprinkled on applesauce for patients with swallowing difficulty
What it depletes.
Nutrients this medication can lower over time, and what to replace.
Zinc
MildACE inhibition has been associated with increased urinary zinc excretion and altered taste in some long-term users.
Full safety detail.
Side effects
- Dry cough
- Hyperkalemia
- Hypotension
- Dizziness
- Angioedema (rare)
- Elevated serum creatinine
- Fatigue
Contraindications
- History of angioedema with ACE inhibitors
- Pregnancy
- Bilateral renal artery stenosis
- Concurrent aliskiren in diabetic patients
- Concurrent sacubitril/valsartan (within 36 hours)
Sources, by evidence tier.
Numbered references. Citations throughout the page link here.
Meta-analyses & systematic reviews
1- 1Meta-analysis of morbidity and mortality in five exercise capacity trials evaluating ramipril in chronic congestive cardiac failurePMIDLubsen J, Chadha DR, Yotof YT et al. · The American journal of cardiology · 1996
Lubsen J, Chadha DR, Yotof YT et al.. Meta-analysis of morbidity and mortality in five exercise capacity trials evaluating ramipril in chronic congestive cardiac failure. The American journal of cardiology. 1996
Randomized controlled trials
4- 2Urine Measurements of the Renin-Angiotensin System-Regulated Proteins Predict Death and Graft Loss in Kidney Transplant Recipients Enrolled in a Ramipril versus Placebo Randomized Controlled TrialPMIDFarkona S, Kotlyar M, Burns K et al. · Journal of proteome research · 2025
Farkona S, Kotlyar M, Burns K et al.. Urine Measurements of the Renin-Angiotensin System-Regulated Proteins Predict Death and Graft Loss in Kidney Transplant Recipients Enrolled in a Ramipril versus Placebo Randomized Controlled Trial. Journal of proteome research. 2025
- 3Ramipril After Transcatheter Aortic Valve Implantation in Patients Without Reduced Ejection Fraction: The RASTAVI Randomized Clinical TrialPMIDAmat-Santos IJ, López-Otero D, Nombela-Franco L et al. · Journal of the American Heart Association · 2024
Amat-Santos IJ, López-Otero D, Nombela-Franco L et al.. Ramipril After Transcatheter Aortic Valve Implantation in Patients Without Reduced Ejection Fraction: The RASTAVI Randomized Clinical Trial. Journal of the American Heart Association. 2024
- 4Ramipril for the Treatment of COVID-19: RAMIC, a Randomized, Double-Blind, Placebo-Controlled Clinical TrialPMIDHuang DQ, Ajmera V, Tomaszewski C et al. · Advances in therapy · 2023
Huang DQ, Ajmera V, Tomaszewski C et al.. Ramipril for the Treatment of COVID-19: RAMIC, a Randomized, Double-Blind, Placebo-Controlled Clinical Trial. Advances in therapy. 2023
- 5Efficacy and Safety of Zofenopril Versus Ramipril in the Treatment of Myocardial Infarction and Heart Failure: A Review of the Published and Unpublished Data of the Randomized Double-Blind SMILE-4 StudyPMIDBorghi C, Omboni S, Novo S et al. · Advances in therapy · 2018
Borghi C, Omboni S, Novo S et al.. Efficacy and Safety of Zofenopril Versus Ramipril in the Treatment of Myocardial Infarction and Heart Failure: A Review of the Published and Unpublished Data of the Randomized Double-Blind SMILE-4 Study. Advances in therapy. 2018
Reference material
5- 6Heart Outcomes Prevention Evaluation Study Investigators. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients (HOPE). N Engl J Med. 2000.Source linkedPMID
- 7AIRE Study Investigators. Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. Lancet. 1993.Source linkedPMID
- 8Rodríguez-Armesto A et al. Effects of polypills on cardiovascular outcomes: Meta-analysis of clinical trials and observational studies. Semergen. 2026.Source linkedPMID
- 9Chauhan M, Patel JB, Ahmad F. Ramipril. 2026Source linkedPMID
- 10Warner GT, Perry CM. Spotlight on ramipril in the prevention of cardiovascular outcomes. American journal of cardiovascular drugs : drugs, devices, and other interventions. 2003Source linkedPMID
Common questions.
Quick answers about Ramipril, drawn from the data on this page.
What is Ramipril?
Ramipril is an ACE inhibitor with strong evidence from the HOPE trial showing cardiovascular risk reduction in high-risk patients without heart failure or low ejection fraction. It is used for hypertension, heart failure, and cardiovascular risk reduction in patients at high risk.
What is Ramipril used for?
Commonly cited benefits of Ramipril include: Reduces cardiovascular death, MI, and stroke in high-risk patients (HOPE trial); Lowers blood pressure; Reduces heart failure progression; Provides nephroprotection in diabetes. NutriStack rates the overall evidence as strong.
What is a typical dose of Ramipril?
A typical adult dose of Ramipril is 1.25–20 mg daily in 1–2 divided doses (as prescribed by your physician). The commonly recommended form is Oral capsule. These are general ranges, not personalized advice; confirm the right dose with a clinician.
What are the side effects of Ramipril?
Reported side effects include dry cough, hyperkalemia, hypotension, dizziness, angioedema (rare), elevated serum creatinine. This is educational information; check with a healthcare professional before use.
How strong is the evidence for Ramipril?
NutriStack rates this as Strong, meaning multiple high-quality meta-analyses or systematic reviews converge on the same finding. Full tier criteria are at https://nutristackapp.com/methodology/evidence-tiers.
Use this with your stack
Ramipril in NutriStack.
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