Cardioprotective potential of angiotensin-converting enzyme inhibitors.

Antihypertensive drugs have various effects, both positive and negative, on metabolic and hemodynamic risk factors for coronary artery disease. Cardioprotective effects of angiotensin-converting enzyme (ACE) inhibitors have recently been described. The benefits of ACE inhibition include not only a reduction in blood pressure but also improved insulin responsiveness, prevention of potassium loss, diminished myocardial oxygen demand, suppression of catecholamines, and interaction with bradykinin and prostaglandins. These benefits result in improved perfusion of vital organs, diminished cardiac work, and protection of coronary vessels, evident in improved left ventricular systolic and diastolic function, elevation of the anginal threshold in ischemic heart disease, and decreased morbidity and mortality in congestive heart failure.