RT Journal Article
SR Electronic
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
FD Canadian Medical Association
SP 293
OP 296
VO 163
IS 3
A1 James M. Wright
YR 2000
UL http://www.cmaj.ca/content/163/3/293.abstract
AB 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.