An Expert Report on the Pharmacological and Clinical Profile of Ramipril (DB00178)

Introduction and Drug Profile

Executive Summary

Ramipril is a long-acting, small-molecule medication that holds a cornerstone position in modern cardiovascular pharmacotherapy.[1] It belongs to the angiotensin-converting enzyme (ACE) inhibitor class of drugs and functions as an inactive prodrug, which undergoes metabolic activation in the body to yield its potent active form, ramiprilat.[1] The therapeutic efficacy of ramipril is rooted in its ability to modulate the renin-angiotensin-aldosterone system (RAAS), a critical physiological pathway that regulates blood pressure and fluid balance.[5] By inhibiting ACE, ramipril effectively reduces the production of angiotensin II, a powerful vasoconstrictor, and prevents the degradation of bradykinin, a vasodilator, thereby lowering blood pressure and reducing cardiac workload.[5]

The clinical applications of ramipril are extensive and well-established. It is indicated for the management of hypertension, the treatment of heart failure following myocardial infarction, and the management of diabetic kidney disease.[1] Perhaps its most significant contribution to clinical practice stems from landmark evidence demonstrating its efficacy in the broad secondary prevention of major cardiovascular events. Ramipril is proven to reduce the rate of death, myocardial infarction, and stroke in a wide range of high-risk individuals, a role that extends beyond its blood-pressure-lowering effects.[1] Ramipril is available by prescription only and is marketed globally under various trade names, with Altace being one of the most widely recognized.[7]

Therapeutic Classification and Role

Ramipril is formally classified based on its mechanism and clinical use: