ACE-Inhibitors in Hypertension: A Historical Perspective and Current Insights

Area of Science:

• Cardiovascular Pharmacology
• Nephrology
• Internal Medicine

Background:

• Angiotensin-converting enzyme (ACE) inhibitors are widely used for hypertension (HTN), heart failure, and kidney disease.
• These drugs inhibit ACE, reducing angiotensin II production, leading to vasodilation and lower blood pressure.
• ACE inhibitors are a first-line HTN treatment alongside diuretics, calcium channel blockers, and ARBs.

Purpose of the Study:

• To review the discovery and development of ACE inhibitors for hypertension.
• To compare the efficacy, tolerability, and safety of ACE inhibitors with ARBs.
• To discuss current issues concerning ACE inhibitor use in HTN management.

Main Methods:

• This is a review article, synthesizing existing research on ACE inhibitors and ARBs.
• Comparative analysis of clinical trial data and observational studies was performed.
• Focus on mechanisms of action, clinical outcomes, and adverse event profiles.

Main Results:

• ACE inhibitors reduce blood pressure by inhibiting angiotensin II synthesis, but bradykinin accumulation can cause angioedema and cough.
• Angiotensin receptor blockers (ARBs) have a lower risk of angioedema and cough as they do not inhibit ACE.
• Recent evidence suggests ARBs may offer neuroprotective benefits, though further research is needed.

Conclusions:

• ACE inhibitors and ARBs are equally recommended as first-line HTN treatments.
• ARBs demonstrate comparable efficacy to ACE inhibitors for HTN with improved tolerability.
• The choice between ACE inhibitors and ARBs may depend on individual patient profiles and risk factors for adverse events.