Angiotensin-converting enzyme inhibitors in the treatment of hypertension

This article examines the evidence justifying the use of angiotensin-converting enzyme (ACE) inhibitors as first-line antihypertensive drugs. ACE inhibitors are as effective as traditional antihypertensive agents and, in addition, exert their blood-pressure-lowering effect with near optimal hemodynamic alterations. These drugs have a good tolerance and safety profile although they induce cough in an appreciable number of patients. They can be safely associated with other antihypertensive agents to provide therapeutic benefit in a large proportion of the hypertensive population. ACE inhibitors are contraindicated only in bilateral renal artery stenosis or stenosis of a single kidney. Although to date no prospective study has examined the ability of ACE inhibitors to reduce cardiovascular morbidity and mortality in hypertension, several features of these drugs suggest that this may be the case as several effects of ACE inhibitors in hypertension are potentially nephroprotective and cardioprotective.