Angiotensin-converting enzyme inhibitors: An ACE in the hole for everyone?

220 ABSTRACT: Angiotensin-converting enyzme inhibitors (ACEIs) are commonly used to treat cardiovascular disorders. The use of ACEIs for hypertension is well established, although these agents have not proven to be superior to other antihypertensive agents. The use of ACEIs in heart failure is also well established, and has proven to reduce morbidity and mortality. ACEIs are now routinely used in myocardial infarction patients to reduce reinfarction and mortality risk, and are combined with a diuretic for secondary prevention in stroke patients. Proof that ACEIs also re duce the progression of diabetic neph ro pathy supports their use in all diabetic patients. With the evidence of efficacy now available, angiotensinconverting enzyme inhibitors should be considered for all patients with diabetes or a history of cardiovas cular disease, except for those at low risk. T he use of angiotensinconverting enzyme inhibi tors (ACEIs) is ubiquitous in the treatment of cardiovascular disorders. These agents inhibit the action of the angiotensinconverting enzyme that catalyzes the conversion of angiotensin I to angio tensin II, a potent vasoconstrictor. Inhibition of angiotensin II results in vasodilation, reduced sodium retention, and reduced sympathetic and renin-angiotensin-aldosterone system activation. There is considerable evidence available supporting the use of ACEIs in patients with hypertension, heart failure, and myocardial infarction (MI), and for prevention of secondary stroke, cardiovascular events, and diabetic nephropathy. ACEIs are considered contraindicated in patients with hyperkalemia, previous angio edema with ACEIs, pregnant patients, and patients with bilateral renal artery stenosis.