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Angiotensin converting enzyme inhibitors: are they preferred first-line therapy?
1Division of Epidemiology, School of Public Health, University of Minnesota, 1300 South 2nd Street, Suite 300, Minneapolis, MN 55454, USA. glasser@epi.umn.edu.
Insights
Diuretics are a recommended first-line therapy for uncomplicated hypertension. However, individual patient needs and comorbid conditions may require alternative or combination antihypertensive drug therapies, including angiotensin converting enzyme (ACE) inhibitors.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Hypertension management aims to lower blood pressure using various therapies.
- Most antihypertensive drugs demonstrate similar efficacy, but individual responses vary.
- Comorbidities affect over 50% of hypertensive patients, influencing treatment choices.
Purpose of the Study:
- To review first-line therapy options for hypertension.
- To discuss the role of diuretics and angiotensin converting enzyme (ACE) inhibitors.
- To highlight the impact of comorbidities on antihypertensive treatment selection.
Main Methods:
- Review of current antihypertensive therapies.
- Analysis of patient response variability.
- Consideration of comorbid conditions in treatment selection.
Main Results:
- Diuretics are suitable for uncomplicated and isolated systolic hypertension.
- Comorbidities necessitate tailored first-line therapies, potentially including ACE inhibitors.
- Multidrug regimens are often required to achieve blood pressure goals.
Conclusions:
- Treatment for hypertension should be individualized based on patient characteristics and comorbidities.
- Angiotensin converting enzyme (ACE) inhibitors are valuable in multidrug regimens.
- Ongoing outcome trials will further refine antihypertensive treatment strategies.
Abstract:
In patients with hypertension, the primary goal is to reduce elevated blood pressure. All of the currently available and approved antihypertensive therapies are, by and large, equally efficacious. Some patient groups and individual patients may, however, respond differentially, and as a result one therapy may be more optimal than another. Overall, for uncomplicated hypertension and particularly for isolated systolic hypertension, diuretics should be considered for first-line therapy. However, comorbid conditions (which occur in > 50% of hypertensive patients) may prompt the need for a more ideal first-line therapy (eg, hypertension with diabetic nephropathy or with left ventricular dysfunction). Regardless, most patients with hypertension will require multidrug therapy to achieve the blood pressure goal, and an angiotensin converting enzyme (ACE) inhibitor may well be part of that therapy. Many going outcome trials comparing the newer therapies (such as ACE inhibitors) with diuretic-based therapy may redefine or clarify the use of different antihypertensive regimens.
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