Angiotensin-converting enzyme inhibitors. Emerging differences and new compounds

Angiotensin-converting enzyme inhibitors (ACEIs), introduced in clinical practice in 1980, are a relatively new class of drugs. They have been useful in the treatment of hypertension, where they are effective monotherapy in 40% to 50% of the patients and in combination therapy in up to 90%. They are also useful in the symptomatic and hemodynamic improvement and in decreasing mortality of patients with congestive heart failure. In this respect, they appear to be superior to other vasodilators. The clinical success of the marketed compounds and the expected increase in market share of these drugs, estimated to approach one billion dollars in the next few years, has created great interest among clinicians and within the drug industry. The emerging differences among the three marketed ACEIs and promising new agents that are expected to be marketed in the next few years are the subject of this review.