Using ACE inhibitors appropriately.
When first introduced in 1981, angiotensin-converting enzyme (ACE) inhibitors were indicated only for treatment of refractory hypertension. Since then, they have been shown to reduce morbidity or mortality in congestive heart failure, myocardial infarction, diabetes mellitus, chronic renal insufficiency, and atherosclerotic cardiovascular disease. Pathologies underlying these conditions are, in part, attributable to the renin-angiotensin-aldosterone system. Angiotensin II contributes to endothelial dysfunction. altered renal hemodynamics, and vascular and cardiac hypertrophy. ACE inhibitors attenuate these effects. Clinical outcomes of ACE inhibition include decreases in myocardial infarction (fatal and nonfatal), reinfarction, angina, stroke, end-stage renal disease, and morbidity and mortality associated with heart failure. ACE inhibitors are generally well tolerated and have few contraindications. (Am Fam Physician 2002;66:473.)
Bicket
Daphne P
DP
Family Practice Residency Program, University of Pittsburgh Medical Center-McKeesport, Pennsylvania 15132, USA. bicketdp@msx.upmc.edu
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001552:Benzazepines / Q000627:therapeutic use; D002216:Captopril / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control; D002986:Clinical Trials as Topic; D000075202:Contraindications; D003928:Diabetic Nephropathies / Q000517:prevention & control; D016527:Drug Costs; D004656:Enalapril / Q000627:therapeutic use; D017328:Fosinopril / Q000627:therapeutic use; D006333:Heart Failure / Q000188:drug therapy; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D007211:Indoles / Q000627:therapeutic use; D007546:Isoquinolines / Q000627:therapeutic use; D017706:Lisinopril / Q000627:therapeutic use; D015201:Meta-Analysis as Topic; D009203:Myocardial Infarction / Q000188:drug therapy; D020913:Perindopril / Q000627:therapeutic use; D000077583:Quinapril; D017257:Ramipril / Q000627:therapeutic use; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012306:Risk; D044005:Tetrahydroisoquinolines; D014481:United States
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D001552:Benzazepines; D007211:Indoles; D007546:Isoquinolines; D044005:Tetrahydroisoquinolines; C052035:trandolapril; D004656:Enalapril; D002216:Captopril; D017706:Lisinopril; D017257:Ramipril; D017328:Fosinopril; D000077583:Quinapril; C044946:benazepril; C058302:moexipril; D020913:Perindopril