ANGIOTENSIN-CONVERTING ENZYME-INHIBITORS IN RAYNAUDS-PHENOMENON

Patients with Raynaud's phenomenon exhibit reversible digital vasospas m, often in response to cold, While this condition often responds to s imple physical measures, in severe cases, symptoms may require drug tr eatment, Arterial vasodilators have usually been tried in clinical pra ctice, but recently ACE inhibitors have been tested in clinical trials of this condition. Case studies, noncomparative and placebo-controlle d studies have shown mixed results of ACE inhibitor therapy in Raynaud 's phenomenon, While these drugs reduced symptoms in some patients, th e results were not consistent. On objective measures of improvement, s uch as evaluation of digital blood flow patterns, consistent statistic ally significant changes have also not been shown. However, well condu cted dose-titration studies have not been performed in patients with R eynaud's phenomenon, and the objective methods of assessing this condi tion require refinement, The mode of action of ACE inhibitors is promi sing 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 stud ies with newer ACE inhibitors, which may have improved peripheral acti vity, may change this view.