Angiotensin-converting enzyme inhibitors in the treatment of mild to moderate essential hypertension.

The rationale for the use of new drugs in the treatment of mild to moderate hypertension is based on the knowledge that these drugs can both achieve the same goals as old drugs and offer additional advantages. Available data indicate that angiotensin-converting enzyme inhibitors (ACEIs) are as effective in reducing blood pressure as thiazide diuretics and beta-blockers, and that they maintain their effect without the development of tolerance. Therefore they may be expected to achieve at least the same prevention of target organ damage (heart failure, cerebral strokes, and arterial nephrosclerosis) as achieved by previous drugs and also to be effective when target organs have already been damaged. Moreover ACEIs seem to offer two possible advantages: cardioprotection and a favorable influence on the quality of life. Many experimental but indeed few clinical data suggest that these drugs can exert primary cardioprotection and that they might exert a beneficial therapeutic effect in hypertensives with coronary heart disease. Owing to the quality of their hypotensive effect, to the lack of detrimental effects on physical, psychical, and sexual activity, and to the positive influence on the sense of well-being, ACEIs seem to be better tolerated than previous drugs. However, although available data suggest that ACEIs can be considered a further advance in the treatment of hypertension, more extensive information is needed to confirm these promising results.