Ramipril should not be used in patients with aortic stenosis or outflow tract obstruction. It should be noted that the elderly or patients with peripheral vascular diseases or generalized atherosclerosis may be at high risk because they may have clinically silent renovascular disease. Renal function should be assessed in all patients prior to administration of ACE inhibitors and should be monitored during therapy. Ramipril should be used with caution in patients with a history of idiopathic or hereditary angioedema. It should also not be used during pregnancy. Ramipril should not be administered to women who are breastfeeding.