Chronic treatment of hypertensive patients with converting enzyme inhibitors.
It is widely accepted that pharmacologic reduction of the blood pressure of hypertensive patients reduces the risk of at least some of the major cardiovascular complications (1-5). All major studies were carried out before orally active converting enzyme inhibitors had become available. In other words, very effective antihypertensive drugs have been around for quite some time and have already proven their efficacy. Therefore, the considerable enthusiasm that has developed during the very recent years for the new converting enzyme inhibitors should be evaluated in the light of previously available antihypertensive drugs, the more so, as drugs cheaper than converting enzyme inhibiting agents are presently available. Thus, the increased expense when using this new class of antihypertensive compounds should be justified by a therapeutic gain. When evaluating a class of antihypertensive drugs such as converting enzyme inhibitors, there are basically three main considerations: What is their efficacy in long-term use? This includes the effect on blood pressure, on heart, on hemodynamics, and on blood flow distribution. What are the metabolic effects? What is the effect on sodium and potassium excretion? How are the serum lipids affected by its use? Are there any untoward effects related either to the chemical structure of the compound per se or rather to the approach? In particular, are there any central effects of the drug which can cause discomfort to the patient? The following discussion has the principal aim to review these aspects with chronic use of oral converting enzyme inhibiting agents without, however, even attempting to provide an exhaustive review of the subject.
Nussberger
J
J
Biollaz
J
J
Waeber
B
B
Brunner
H R
HR
D000803:Angiotensin I / Q000378:metabolism; D000804:Angiotensin II / Q000378:metabolism; D000806:Angiotensin-Converting Enzyme Inhibitors; D000818:Animals; D001794:Blood Pressure / Q000187:drug effects; D002560:Cerebrovascular Circulation / Q000187:drug effects; D002986:Clinical Trials as Topic; D003326:Coronary Circulation / Q000187:drug effects; D004656:Enalapril / Q000494:pharmacology / Q000627:therapeutic use; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D008055:Lipids / Q000097:blood; D009842:Oligopeptides / Q000494:pharmacology / Q000627:therapeutic use*; D007703:Peptidyl-Dipeptidase A / Q000494:pharmacology / Q000627:therapeutic use; D011188:Potassium / Q000652:urine; D051381:Rats; D011918:Rats, Inbred SHR; D012083:Renin / Q000097:blood; D012964:Sodium / Q000652:urine; D013722:Teprotide / Q000627:therapeutic use
D000806:Angiotensin-Converting Enzyme Inhibitors; D008055:Lipids; D009842:Oligopeptides; D000804:Angiotensin II; D004656:Enalapril; D000803:Angiotensin I; D012964:Sodium; D013722:Teprotide; D007703:Peptidyl-Dipeptidase A; D012083:Renin; D011188:Potassium