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Chronic treatment of hypertensive patients with converting enzyme inhibitors
Insights
Newer converting enzyme inhibitors for hypertension offer potential benefits but require evaluation against established, cheaper drugs. Their long-term efficacy, metabolic effects, and side effects must justify increased costs for therapeutic gain.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
Background:
- Pharmacologic blood pressure reduction is proven to reduce cardiovascular risk.
- Previous studies predated the availability of effective oral converting enzyme inhibitors.
- Existing antihypertensive drugs are effective and often more affordable.
Purpose of the Study:
- To evaluate the efficacy and safety of oral converting enzyme inhibitors in chronic use.
- To compare new converting enzyme inhibitors with previously available antihypertensive drugs.
- To determine if the increased cost of converting enzyme inhibitors is justified by therapeutic gains.
Main Methods:
- Review of long-term efficacy, including effects on blood pressure, heart, hemodynamics, and blood flow distribution.
- Assessment of metabolic effects, including sodium and potassium excretion and serum lipid impact.
- Evaluation of adverse effects, including chemical structure-related and central nervous system effects.
Main Results:
- Efficacy in long-term use requires comprehensive assessment.
- Metabolic and hemodynamic effects need thorough investigation.
- Potential adverse effects, including central effects, must be considered.
Conclusions:
- Converting enzyme inhibitors represent a significant advancement in hypertension management.
- Their long-term benefits and safety profile warrant careful consideration against existing therapies.
- Justification of increased cost requires demonstrable therapeutic advantages.
Abstract:
It is widely accepted that pharmacologic reduction of the blood pressure of hypertensive patients reduces the risk of at least some of the major cardiovascular complications (1-5). All major studies were carried out before orally active converting enzyme inhibitors had become available. In other words, very effective antihypertensive drugs have been around for quite some time and have already proven their efficacy. Therefore, the considerable enthusiasm that has developed during the very recent years for the new converting enzyme inhibitors should be evaluated in the light of previously available antihypertensive drugs, the more so, as drugs cheaper than converting enzyme inhibiting agents are presently available. Thus, the increased expense when using this new class of antihypertensive compounds should be justified by a therapeutic gain. When evaluating a class of antihypertensive drugs such as converting enzyme inhibitors, there are basically three main considerations: What is their efficacy in long-term use? This includes the effect on blood pressure, on heart, on hemodynamics, and on blood flow distribution. What are the metabolic effects? What is the effect on sodium and potassium excretion? How are the serum lipids affected by its use? Are there any untoward effects related either to the chemical structure of the compound per se or rather to the approach? In particular, are there any central effects of the drug which can cause discomfort to the patient? The following discussion has the principal aim to review these aspects with chronic use of oral converting enzyme inhibiting agents without, however, even attempting to provide an exhaustive review of the subject.