Angiotensin-converting enzyme inhibitors in hypertension and congestive heart failure

Abstract EN

-The place of angiotensin-converting enzyme (ACE) inhibition as first choice approach in the treatment of hypertension is now firmly established.

Clearly, if a patient with a totally asymptomatic disease is to be expected to comply with a life-long drug treatment meant to prevent future uncertain complications, he should, at least, be provided with a treatment that will not affect his present quality of life, and will not produce effects that may themselves become risk factors.

Accordingly, the perfect antihypertensive agent should have the following characteristics: it should lower systemic vascular resistance, the common mechanism by which all types of hypertension are sustained; it should maintain or improve regional blood flows to vital organs, i.e., insure adequate perfusion of the cerebral, coronary and renal vasculature; it should preserve optimal cardiac performance, i.e., it should have no negative effects on cardiac contractility and conductivity; it should prevent the retention of salt and fluid, a common side-effect of many antihypertensive agents, that may be partly responsible for “escape” of good blood pressure control; it should avoid reflex sympathetic activation, which adversely affects the heart’s economy; it should not interfere with various metabolic processes, such as glucose, electrolyte and lipid metabolism, i.e.

effects that have been incriminated in the failure of some drugs to prevent coronary complications; it should not interact with common drugs used to treat coexisting diseases, such as hypoglycemics, antidepressants, antiasthmatics,...

etc.; and finally, it should not adversely affect the psychosocial performance of otherwise healthy individuals leading active and demanding lives.

Obviously, no perfect drug exists yet, but ACE inhibitors come closest to fulfilling most of these re- Address correspondence io: Haralambos, Gavras, M.D., Chief Hypertension and Atherosclerosis Section, Boston University School of Medicine, L217, 80 East Concord Street, Boston, Massachusetts 02118, U.S.A.