The ACE inhibitors are one of the first choice drugs in all grades of essential as well as renovascular hypertension (except those with bilateral renal artery stenosis). Most patients require relatively lower doses (enalapril 2.5—10 mg/day or equivalent) which are well tolerated.
Used alone Angiotensin Converting Enzyme Inhibitors control hypertension in —50% patients, and addition of a diuretic or a Beta blocker extends efficacy to —90%. Because of supraadditive synergism, only a low dose of diuretic (12.5 mg of hydrochlorothiazide, rarely 25 mg) needs to be added. The pharmacology and use of ACE inhibitors in hypertension are well known. Of particular mention are their renal blood flow improving action, their potential to retard diabetic nephropathy and their capacity to regress left ventricular/vascular hypertrophy. Angiotensin Converting Enzyme Inhibitors are the most appropriate antthypertensives in patients with diabetes, nephropathy (even nondiabetic), left ventricular hypertrophy, CHF, angina and post MI cases. Several large prospective studies including AIRE (1993), HOPE (2000), ALLHAT (2002) have confirmed the antihypertensive and cardioprotective effects of ACE inhibitors. Angiotensin Converting Enzyme Inhibitors appear to be more effective in younger (<55 year) hypertensives than in the elderly. Dry persistent cough is the most common side effect requiring discontinuation of ACE inhibitors.