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Angiotensin-converting enzyme inhibitors: a comparative review
J J Raia1, J A Barone, W G Byerly
1Department of Pharmacy Practice and Administration, Rutgers University, Piscataway, NJ.
DICP : the Annals of Pharmacotherapy
|May 1, 1990
Summary
Angiotensin-converting enzyme (ACE) inhibitors lower blood pressure by inhibiting angiotensin II formation. These drugs, including captopril, enalapril, and lisinopril, are effective for hypertension and heart failure.
Area of Science:
- Pharmacology
- Cardiovascular Medicine
- Nephrology
Background:
- Angiotensin-converting enzyme (ACE) inhibitors block the conversion of angiotensin I to angiotensin II.
- Angiotensin II is a vasoconstrictor that also stimulates sodium and water retention via aldosterone.
- ACE inhibitors reduce blood pressure through vasodilation and decreased fluid volume.
Purpose of the Study:
- Review the chemistry, pharmacology, pharmacokinetics, adverse effects, and dosages of available ACE inhibitors.
- Compare and contrast the properties of captopril, enalapril, and lisinopril.
- Evaluate the efficacy of ACE inhibitors in hypertension and heart failure.
Main Methods:
- Literature review of existing studies on ACE inhibitors.
- Analysis of pharmacokinetic profiles, including onset, duration, metabolism, and excretion.
- Comparison of clinical efficacy against other antihypertensive agents and in heart failure.
Main Results:
- Captopril is a sulfhydryl-containing ACE inhibitor with rapid onset and short duration.
- Enalapril and lisinopril are non-sulfhydryl ACE inhibitors with slower onset and longer duration.
- ACE inhibitors effectively lower blood pressure, comparable to diuretics and beta-blockers, and benefit patients with heart failure.
Conclusions:
- ACE inhibitors are a cornerstone therapy for hypertension and heart failure.
- Pharmacokinetic differences influence the choice and dosing of ACE inhibitors.
- Combination therapy with diuretics can enhance the antihypertensive effects of ACE inhibitors.