Role of angiotensin-converting-enzyme inhibitors in the treatment of hypertension

Therapeutic goals for the treatment of hypertension and the ability of vari ous angiotensin-converting-enzyme (ATE) inhibitors to meet these goals are presented. The 1997 Sixth Report of the Joint National Committee on Prevention, Detect ion, Evaluation, and Treatment of High Blood Pressure (JNC-VI) does not rec ommend ACE inhibitors for first-line therapy in the treatment of hypertensi on; however, these guidelines do identify compelling indications for ACE in hibitor therapy, including diabetes mellitus (type 1) with proteinuria, hea rt failure, or previous myocardial infarction with systolic dysfunction. Si nce the JNC-VI guidelines were developed, the results of a prospective rand omized clinical trial in patients with uncomplicated hypertension have demo nstrated that ACE inhibitor therapy is as effective as conventional treatme nt in the prevention of cardiovascular morbidity and mortality. in hyperten sive patients with diabetes, therapy with captopril, enalapril, fosinopril, or ramipril has resulted in significant reductions in cardiovascular event s. In addition, tight blood pressure control with an ACE inhibitor has resu lted ina,greater reduction in the risk of macrovascular and microvascular c omplications of diabetes than was seen with less tight control. Recent:study results support broader use of ACE inhibitors for hypertension than was:recommended in the JNC-VI guidelines.