Management of hypertension and its sequelae with ACE inhibitors: biochemical, pharmacological and clinical aspects.

ACE inhibitors are a widely prescribed class of drug for the management of hypertension. Their therapeutic role in the treatment of heart failure, diabetic nephropathy and post myocardial infarction with left ventricular dysfunction is steadily increasing. Although ACE inhibitors have a similar mechanism of action--namely, inhibition of circulatory ACE, thereby decreasing the formation of angiotensin II--individual members differ in their physicochemical properties, enzyme-binding kinetics, pharmacokinetic profile, organ-specific affinity and selectivity, as well as in their bradykinin potentiating effect. These factors play an important part in influencing the pharmacological profile of an agent and its clinical efficacy, especially in the treatment of hypertension. It is therefore prudent to take into account the existing pharmacological and clinically relevant differences between the individual members of this drug class before making the decision to select a particular ACE inhibitor for the long-term management of arterial hypertension.