ENALAPRIL - A REAPPRAISAL OF ITS PHARMACOLOGY AND THERAPEUTIC USE IN HYPERTENSION

Enalapril, an angiotensin converting enzyme (ACE) inhibitor usually ad ministered orally once daily, decreases blood pressure by lowering per ipheral vascular resistance without increasing heart rate or output. I t is effective in lowering blood pressure in all grades of essential a nd renovascular hypertension. Patients not responding adequately to en alapril monotherapy usually respond with the addition of a thiazide di uretic (or a calcium antagonist or beta-blocker), and rarely require a third antihypertensive agent. Enalapril is at least as effective as o ther established and newer ACE inhibitors, and members of other antihy pertensive drug classes including diuretics, beta-blockers, calcium an tagonists and alpha-blockers, but therapy with enalapril may be less f requently limited by serious adverse effects or treatment contraindica tions than with other drug classes. The most frequent adverse effect l imiting all ACE inhibitor therapy in clinical practice is cough. This favourable profile of efficacy and tolerability, and the substantial w eight of clinical experience, explain the increasing acceptance of ena lapril as a major antihypertensive treatment and supports its use as l ogical first-line therapeutic option.