Angiotensin converting enzyme inhibitors: differences and advantages for first line therapy in hypertension.

Abstract

There are now numerous angiotensin converting enzyme (ACE) inhibitors under development, clinical trial or in clinical use for cardiovascular disease, a situation analagous to the beta blockers. They currently vary in their chemical and physical structure, whether they contain a sulphydril group or are pro-drugs, and in their pharmacokinetics. Whether these differences will convey any special or particular clinical advantages to individual ACE inhibitors has yet to be established. Further research is necessary to determine whether tissue ACEs are merely isoenzymes or whether they differ in their functional properties. Different bioavailability in tissues of the individual ACE inhibitors could confer differing pharmacodynamic properties. ACE inhibitors have been a major advance in the treatment of hypertension and heart failure. In heart failure they have been shown to improve the haemodynamics, to improve symptoms, and most recently, to prolong survival. In hypertension, ACE inhibitors have some physiological advantages over current antihypertensive agents. They have several favourable cardiovascular effects without metabolic disadvantages which provide a theoretical basis for cardio-protection in hypertensive patients.