[Angiotensin converting enzyme inhibitors and vascular remodelling in arterial hypertension]

The prescription of angiotensin converting enzyme (ACE) inhibitors contributes in everyday practice to the normalisation of blood pressure (BP) in individuals with essential hypertension (HT). Inhibition of the circulating renin angiotensin system (RAS) is accompanied, acutely, by a fall in BP. The effects of ACE inhibitors in the longer term is more complicated, including inhibition of tissue RAS and, finally, an action on the vascular structure itself which is apparently of fundamental importance. ACE inhibitors contribute to improving compliance of major arteries and to decreasing arteriolar resistance while leaving regional blood flow unaffected. There are additional beneficial modes of action such as the reversibility of endothelial dysfunction or inhibition of the cell migrations which are a prelude to atherosclerosis. These effects may be linked to the therapeutic group, but certain ACE inhibitors with particular tissue tropism have a more effective action regarding tissue RAS. This might be associated with a more significant fall in HT-related cardiovascular morbidity.