December 8, 1988New England Journal of Medicine
Converting-Enzyme Inhibitors in the Treatment of Hypertension
Why the study?
Are converting-enzyme inhibitors effective and safe in the treatment of hypertension?
Population
Patients with hypertension
Comparison
Converting-enzyme inhibitors vs Placebo
Design
Review
Authors
Discussion
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Implication
Early ACE inhibitor literature provides historical context; leaves open relevance to contemporary hypertension guidelines and agents.
Key Points
- To review the pharmacokinetics, biochemical mechanisms, clinical efficacy, and safety profiles of the six most widely studied converting-enzyme inhibitors in the management of hypertension.
- Searched MEDLARS from January 1983 through August 1987, identifying over 1,200 reports on 16 converting-enzyme inhibitors.
- Restricted the clinical efficacy analysis to double-blind, placebo-washout comparison studies for the six most frequently reported agents: captopril, enalapril, lisinopril, pentopril, ramipril, and alacepril.
- Demonstrated qualitative consistency in blood pressure reduction across double-blind placebo-washout trials evaluating the primary converting-enzyme inhibitors.
- Characterized distinct pharmacokinetic profiles and tabulated comparative side-effect frequencies for captopril, enalapril, lisinopril, pentopril, ramipril, and alacepril.
Structured PICO
Are converting-enzyme inhibitors effective and safe in the treatment of hypertension?
P
Population
Patients with hypertension
I
Intervention
Converting-enzyme inhibitors (captopril, enalapril, lisinopril, pentopril, ramipril, or alacepril)
C
Comparator
Placebo
O
Outcome
Clinical efficacy in hypertension
This review summarizes the clinical use, pharmacokinetics, and side effects of six major ACE inhibitors for the treatment of hypertension based on literature from 1983 to 1987.
Cite This Study
Oates et al. (1988) studied this question.