Therapeutic Progress–review Xxix Is There a Role for Low-Dose Angiotensin Converting Enzyme Inhibitors in the Treatment of Mild to Moderate Hypertension?

I N T R O D U C T I O N Angiotensin converting enzyme (ACE) inhibitors have been used to treat hypertension for many years and their general mode of action has been well described (1-3).However, their pattern of use has changed markedly.In the past large doses of captopril were prescribed for patients with severe hypertension usually associated with renal impairment and often caused by an underlying collagen disease.More recently captopril, at a much lower dosage, and the second ACE inhibitor, enalapril, have been used to treat patients with uncomplicated mild to moderate hypertension.Used in this way ACE inhibitors seem not only effective but also safe and well tolerated.ACE inhibitors must now be seen as competitors to diuretics, /%blockers, and calcium antagonists as a first-line treatment for hypertension.Therefore, it seems appropriate to review the requirements for a good antihypertensive agent and to compare ACE inhibitors with the other three groups of drugs in relation to those requirements.This is the first objective of this paper; the second is to present the clinically relevant data on captopril and enalapril. T H E IDEAL ANTIHYPERTENSIVEWhen pharmacological methods are required to treat mild to moderate hypertension, the treatment should be:(a) simple to administer, (b) safe to take, (c) well tolerated, (d) effective, (e) inexpensive, (f) neutral or helpful in relation to its influence on the risk of developing or suffering adversely from the consequences of ischaemic heart disease and cerebrovascular disease.