[Rational criteria for the choice of ACE inhibitor adapted to the individual hypertensive patient].

Attempts to rationalise the treatment of hypertension on the basis of pathophysiological and clinical characteristics of patients, such as renin profile and age, have had minimal success in the past. More recently it has been found that the response to ACE inhibitors or calcium antagonists might be predicted on the basis of the ability of the kidney to produce kallikrein. Urinary excretion of active kallikrein is considered an index of the activity of the renal-kallikrein system and this system is thought to play an important role in modulating the effects of ACE inhibitors. In patients with low urinary kallikrein excretion the efficacy of ACE inhibitors is blunted and, on the contrary, that of calcium antagonists seems to be enhanced. Among ACE inhibitors the choice of a specific drug might also-based upon the effects of the molecule on the tissue renin-angiotensin system. In this regard lipophilic ACE inhibitors, such as ramipril, may produce a therapeutic effect at doses which are better tolerated due to greater tissue penetration.