Angiotensin converting enzyme inhibitors in Raynaud's phenomenon

Patients with Raynaud's phenomenon exhibit reversible digital vasospasm, often in response to cold. While this condition often responds to simple physical measures, in severe cases, symptoms may require drug treatment. Arterial vasodilators have usually been tried in clinical practice, but recently ACE inhibitors have been tested in clinical trials of this condition. Case studies, noncomparative and placebo-controlled studies have shown mixed results of ACE inhibitor therapy in Raynaud's phenomenon. While these drugs reduced symptoms in some patients, the results were not consistent. On objective measures of improvement, such as evaluation of digital blood flow patterns, consistent statistically significant changes have also not been shown. However, well conducted dose-titration studies have not been performed in patients with Reynaud's phenomenon, and the objective methods of assessing this condition require refinement. The mode of action of ACE inhibitors is promising and these agents do not have significant adverse effects in this population. While at present ACE inhibitors cannot be recommended for the routine treatment of Reynaud's phenomenon, further controlled studies with newer ACE inhibitors, which may have improved peripheral activity, may change this view.