Angiotensin-Converting Enzyme Inhibitors in Essential Hypertension

At the Cambridge Conference, the pros and cons of various classes of antihypertensive drugs were extensively discussed, including the place of angiotensin-converting enzyme inhibitors in today's spectrum. A consensus was easily reached that the most important advantage of having the present broad armamentarium of antihypertensive drugs is that a wide choice is now available from which to find the most suitable agent for the individual patient. A revised stepped-care design was proposed, in which the doctor has the choice of starting antihypertensive therapy with a thiazide diuretic, a beta-blocker, an angiotensin-converting enzyme inhibitor, or a calcium antagonist. Small doses of any agent should be used to start with, and doses should not subsequently be increased beyond that at which side effects appear. Should such symptoms occur, the doctor has the choice of either switching to another first-step compound or reducing the dose of the first agent and combining it with one of other available drugs.