Heart Medications for Pets: ACE Inhibitors and Beyond
Understanding the medications used to treat heart disease and high blood pressure in dogs and cats — from ACE inhibitors to newer ARB medications.
The renin-angiotensin-aldosterone system (RAAS) is a complex hormonal system that regulates blood pressure and fluid balance. When chronically activated by heart or kidney disease, it can worsen the condition. Medications that suppress RAAS — including ACE inhibitors (enalapril, benazepril), ARBs (telmisartan), and spironolactone — are cornerstones of heart disease and kidney disease treatment in veterinary medicine. Source: Clinician's Brief, 2025.
Key Points
- ACE inhibitors (enalapril, benazepril) and ARBs (telmisartan) are the most commonly prescribed heart medications
- These medications reduce strain on the heart by relaxing blood vessels and reducing fluid retention
- Telmisartan (an ARB) is increasingly preferred over ACE inhibitors for treating proteinuria in dogs
- For cats with high blood pressure, amlodipine is the first-choice treatment
- Regular blood work monitoring (kidney function, potassium) is essential while on these medications
- Never stop heart medications suddenly — always consult your vet first
ACE Inhibitors vs ARBs
ACE inhibitors (enalapril, benazepril) have been the traditional choice for heart disease and kidney proteinuria. ARBs (telmisartan) are newer and increasingly preferred because they provide greater reduction in proteinuria and preserve beneficial effects of angiotensin II. In dogs, ARBs are now the first choice for proteinuria. In cats, both are equally recommended. Both medication types require regular monitoring of kidney function and electrolytes.
Treating High Blood Pressure
Systemic hypertension (high blood pressure) affects many cats and dogs with kidney disease or heart disease. In cats, amlodipine (a calcium channel blocker) is the first-choice treatment, typically 0.625-1.25 mg daily. In dogs, ACE inhibitors or ARBs are first-line. For severe hypertension (systolic >200 mmHg), combination therapy may be needed. Regular blood pressure monitoring is essential to ensure treatment is effective.
Monitoring on Heart Medications
Pets on ACE inhibitors, ARBs, or spironolactone need regular monitoring: kidney function (BUN, creatinine), electrolytes (especially potassium), and blood pressure. Monitoring is typically done 1-2 weeks after starting or changing dose, then every 3-6 months. Side effects may include decreased appetite, vomiting, or weakness (signs of kidney issues or high potassium). Report any of these to your vet immediately.
Living with Heart Disease
Many pets with heart disease live comfortably for months to years with proper medication. Key management: give medications consistently at the same time daily, never skip doses, monitor breathing rate at home (normal resting rate <30 breaths/minute), watch for worsening symptoms (increased coughing, exercise intolerance, abdominal swelling), and maintain regular vet checkups. Your pet can still enjoy a good quality of life with appropriate cardiac care.
When to See a Vet Immediately
- Your pet has been diagnosed with heart disease and needs medication management
- Your pet's resting breathing rate exceeds 30 breaths per minute
- Your pet is coughing more, especially at night or after exercise
- Your pet shows decreased appetite, vomiting, or lethargy while on heart medication
- Your pet's abdomen appears swollen or distended
- Your pet faints, collapses, or has difficulty breathing
How RVC Can Help
Royal Veterinary Center provides comprehensive cardiac care including echocardiography, blood pressure monitoring, ECG, and cardiac biomarker testing. We prescribe and monitor all heart medications including ACE inhibitors, ARBs, amlodipine, and spironolactone. Our team creates individualized treatment plans and provides home monitoring guidance for pet owners managing heart disease. Call +853 6677 6611.
This article is for educational purposes only and does not replace professional veterinary advice. If your pet is showing any symptoms, please contact Royal Veterinary Center immediately at +853 6677 6611.