Can I drink alcohol while taking an angiotensin-converting enzyme (ACE) inhibitor?

Manufacturers of angiotensin-converting enzyme (ACE) inhibitor have no information or recommendation regarding the specific use of ACE inhibitors while drinking alcohol.^1-13 They do say ACE inhibitor can cause symptomatic hypotension with dizziness or lightheadness anytime during therapy, but particularly with an initial or increased dose. Patient who are volume- or salt-depleted are at higher risk for hypotension. Examples include those who:

• take water pills (diuretics)
• are on a low-salt diet
• take other medicines that affect your blood pressure
• get sick with vomiting or diarrhea
• do not drink enough fluids 

According to the 2017 American College of Cardiology and American Heart Association (ACC/AHA) hypertension guidelines, alcohol is a substance that has the potential to impair blood pressure control.¹⁴ They recommend limiting alcohol to ≤1 drink daily for women and ≤2 drinks for men. In the United States, one “standard” drink contains roughly 14 g of pure alcohol, which is typically found in 12 oz of regular beer (usually about 5% alcohol), 5 oz of wine (usually about 12% alcohol), and 1.5 oz of distilled spirits (usually about 40% alcohol).^14-16 Evidence reviewed by the panel shows that for heavy drinkers, reducing alcohol intake to this amount may result in a reduction of blood pressure by -4 mm Hg systolic and -3mm Hg diastolic or more, regardless of other interventions.^14,17-20

Excessive alcohol consumption causes about 16% of hypertension cases worldwide.^21,22 Drinking more than two alcoholic drinks per day raises the risk of high blood pressure.^23,24

The Dietary Guidelines for Americans 2015-2020 states that if alcohol is consumed, it should be in moderation—up to one drink per day for women and up to two drinks per day for men—and only by adults of legal drinking age. For those who choose to drink, moderate alcohol consumption is recommended.²⁵

^References

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25. 2015 – 2020 dietary guidelines for Americans. 8 ed: U.S. Department of Health and Human Services and U.S. Department of Agriculture; 2015.