What Blood Pressure Medication Is Taken with Ramipril?

October 10, 2025 •

4 min read

Studies show initial combination therapy for hypertension is associated with better long-term blood pressure control [1.8.6]. This leads many to ask, what blood pressure medication is taken with ramipril to achieve these results and effectively manage hypertension? [1.8.6]

Quick Summary

Ramipril, an ACE inhibitor, is often combined with diuretics like hydrochlorothiazide or calcium channel blockers like amlodipine to enhance blood pressure reduction by targeting different biological pathways [1.2.2, 1.5.2].

Key Points

Primary Combinations: Ramipril is most frequently prescribed with thiazide diuretics, like hydrochlorothiazide, or calcium channel blockers, like amlodipine [1.2.2, 1.5.2].
Enhanced Efficacy: Combining drugs that work differently provides a synergistic effect, lowering blood pressure more effectively than a single medication [1.8.1].
Important Contraindications: Ramipril should generally not be taken with ARBs (like losartan) or sacubitril due to increased risks of kidney problems and angioedema [1.7.4, 1.4.5].
NSAID Interaction: Common pain relievers like ibuprofen can reduce ramipril's effectiveness and increase the risk of kidney damage when used together [1.6.2, 1.7.6].
Fixed-Dose Pills: Many ramipril combinations are available as a single pill, which can simplify treatment and improve patient adherence [1.8.4].
Side Effect Mitigation: Combination therapy can sometimes reduce side effects; for instance, ramipril can lessen the ankle swelling caused by amlodipine [1.3.5].
Potassium Risk: Combining ramipril with potassium supplements or potassium-sparing diuretics is risky and can lead to dangerously high blood potassium levels (hyperkalemia) [1.2.4, 1.6.1].

Understanding Ramipril and Combination Therapy

Ramipril is an angiotensin-converting enzyme (ACE) inhibitor used to treat high blood pressure (hypertension) and heart failure [1.2.2]. It works by relaxing and widening blood vessels, making it easier for the heart to pump blood [1.5.5]. However, hypertension is often caused by multiple factors, and a single medication may not be sufficient to bring blood pressure to a target level. In fact, it is estimated that at least 75% of patients require combination therapy to achieve their blood pressure goals [1.8.3].

Combining ramipril with another antihypertensive medication from a different class can provide a more powerful blood-pressure-lowering effect by targeting the condition from multiple angles [1.8.1]. This approach can also allow for the use of lower doses of each drug, potentially reducing the risk and severity of side effects compared to a high dose of a single agent. Many of these combinations are available in a single, fixed-dose combination pill, which can improve medication adherence [1.8.4].

Diuretics: The Most Common Pairing

The most frequent combination involves pairing ramipril with a thiazide diuretic, most commonly hydrochlorothiazide (HCTZ) [1.2.2, 1.8.6].

How it Works: Diuretics, often called "water pills," help the body get rid of excess salt and water [1.4.3]. This reduction in fluid volume lowers blood pressure. Ramipril relaxes the blood vessels, and HCTZ reduces the amount of fluid within them, creating a potent dual action [1.2.2].
Benefits: Studies have shown that combinations of ramipril and HCTZ produce significantly greater blood pressure reductions than either component alone [1.3.2]. Additionally, ramipril can help counteract the potassium loss that can be a side effect of HCTZ [1.3.2].
Considerations: While effective, this combination requires monitoring of electrolytes by a healthcare provider [1.4.5]. Common side effects can include dizziness, headache, and a persistent dry cough from the ramipril component [1.4.3, 1.4.5].

Calcium Channel Blockers (CCBs): An Effective Alternative

Another highly effective and common combination is ramipril with a calcium channel blocker (CCB), such as amlodipine or felodipine [1.5.2, 1.3.3].

How it Works: CCBs like amlodipine work by relaxing blood vessels, allowing blood to flow more easily [1.5.5]. This mechanism is complementary to ramipril's action on the renin-angiotensin system. The result is a synergistic lowering of blood pressure [1.3.5].
Benefits: Research indicates that a fixed-dose combination of ramipril and amlodipine is significantly more effective at reducing blood pressure than amlodipine monotherapy [1.3.5, 1.5.1]. This combination has also been shown to be well-tolerated and effective in patients with both hypertension and diabetes [1.5.1]. A notable benefit is that the addition of ramipril can reduce the prevalence of ankle swelling (edema), a common side effect of amlodipine [1.3.5].
Considerations: Regular monitoring of blood pressure, kidney function, and electrolyte levels is advised while taking a ramipril and amlodipine combination [1.5.5].

Comparison of Common Ramipril Combinations


Feature	Ramipril + Hydrochlorothiazide (Diuretic)	Ramipril + Amlodipine (CCB)
Primary Mechanism	Relaxes blood vessels and reduces body fluid volume [1.2.2].	Relaxes blood vessels through two different pathways [1.5.5].
Primary Benefit	Strong, synergistic blood pressure reduction; ramipril mitigates potassium loss from HCTZ [1.3.2].	Significant blood pressure reduction; ramipril can reduce CCB-induced ankle swelling [1.3.5].
Common Side Effects	Dizziness, dry cough, increased urination, potential electrolyte imbalance [1.4.5, 1.4.7].	Dizziness, headache, flushing, fatigue; cough from ramipril [1.5.5].
Ideal Candidate	Patients who may benefit from fluid reduction or who need a very common and well-studied combination [1.8.6].	Patients who are sensitive to diuretic side effects or who experience ankle swelling with CCB monotherapy [1.3.5].

Medications to Use with Caution or Avoid

It is critical to be aware of potential drug interactions when taking ramipril, especially in a combination therapy regimen.

Angiotensin II Receptor Blockers (ARBs): Combining ramipril (an ACE inhibitor) with an ARB (e.g., losartan, valsartan) is generally not recommended and is contraindicated in patients with diabetic nephropathy. This "dual RAAS blockade" increases the risk of hypotension (low blood pressure), hyperkalemia (high potassium), and kidney damage [1.7.4, 1.2.4].
Potassium-Sparing Diuretics and Potassium Supplements: Ramipril can increase potassium levels in the blood [1.6.5]. Combining it with potassium-sparing diuretics (like spironolactone) or potassium supplements can lead to dangerously high potassium levels (hyperkalemia) [1.2.4, 1.6.1].
NSAIDs (Nonsteroidal Anti-Inflammatory Drugs): Common pain relievers like ibuprofen and naproxen can reduce the blood-pressure-lowering effect of ramipril and increase the risk of kidney problems, especially in older adults or those with pre-existing kidney disease [1.6.2, 1.7.6].
Sacubitril: Combining ramipril with sacubitril (part of the medication Entresto) is contraindicated due to a heightened risk of angioedema (severe swelling) [1.4.5].

Conclusion

The most common and effective blood pressure medications taken with ramipril are thiazide diuretics (like hydrochlorothiazide) and calcium channel blockers (like amlodipine) [1.2.2, 1.5.2]. These combinations target hypertension through complementary mechanisms, leading to better blood pressure control often with improved tolerability compared to high-dose monotherapy [1.3.5, 1.8.1]. However, certain combinations, particularly with ARBs, potassium-sparing drugs, and NSAIDs, should be avoided due to increased risks [1.7.4, 1.6.2]. The choice of medication is highly individualized, and treatment should always be guided by a healthcare professional who can monitor for side effects and ensure the regimen is safe and effective.

For more information on hypertension management, consult authoritative sources like the American Heart Association.

Frequently Asked Questions

Yes, ramipril and amlodipine are frequently prescribed together. This combination is effective for treating high blood pressure as they work in complementary ways to relax blood vessels [1.5.2, 1.5.5].

The most common diuretic combined with ramipril is hydrochlorothiazide (HCTZ). This combination is widely used and is available as a fixed-dose tablet [1.2.2, 1.8.6].

Taking ibuprofen (an NSAID) with ramipril can make the ramipril less effective at lowering blood pressure and may increase the risk of kidney damage, especially with frequent use [1.6.2, 1.7.6].

Yes, it is often necessary and safe to take two different types of blood pressure pills, known as combination therapy. This approach can be more effective at controlling blood pressure than a single medication [1.8.1, 1.8.3]. Always follow your doctor's prescription.

Signs of a serious reaction can include angioedema (swelling of the face, lips, or throat), severe dizziness or fainting, difficulty breathing, or symptoms of high potassium like weakness and irregular heartbeat [1.4.3, 1.6.5]. Seek immediate medical attention if these occur.

You should generally avoid taking potassium supplements or using salt substitutes containing potassium while on ramipril, unless specifically told to by your doctor. The combination can cause unsafe increases in your blood potassium levels [1.6.1, 1.2.4].

A fixed-dose combination pill contains two or more different medications in a single tablet or capsule. For example, a pill might contain both ramipril and hydrochlorothiazide. This simplifies the medication regimen and can help with adherence [1.8.4].