TY - JOUR T1 - Choosing a first-line drug in the management of elevated blood pressure: What is the evidence? 3: Angiotensin-converting-enzyme inhibitors JF - Canadian Medical Association Journal JO - CMAJ SP - 293 LP - 296 VL - 163 IS - 3 AU - James M. Wright Y1 - 2000/08/08 UR - http://www.cmaj.ca/content/163/3/293.abstract N2 - ELEVATED BLOOD PRESSURE IS ASSOCIATED WITH AN INCREASED risk of cardiovascular illness and death. Efforts to reduce that risk have led to recommendations for a wide array of nondrug and drug therapies. Choosing the optimal first-line drug for hypertensive patients should address a hierarchy of treatment goals: decrease in morbidity and mortality associated with hypertension, decrease in blood pressure and other surrogate markers, good tolerance, dosing convenience and low cost. This article examines the evidence for angiotensin-converting-enzyme (ACE) inhibitors as a class of first-line antihypertensive drugs in light of these treatment goals. Overall, the evidence does not support the use of ACE inhibitors as first-line drugs in the management of most patients with hypertension, although they have proven benefit as second-line drugs for the treatment of congestive heart failure and left ventricular dysfunction secondary to myocardial infarction. ER -