ACE inhibitors. A safe option for hypertension and congestive heart failure.

The Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure has recently recommended angiotensin-converting enzyme (ACE) inhibitors, beta blockers, and diuretics as potential first-step agents for the pharmacologic treatment of hypertension. ACE inhibitors should be considered an important option in most patients because of their safety profile, absence of adverse metabolic effects, and positive cardiac and renal effects. If the response to an ACE inhibitor is inadequate, a diuretic or another agent can be added, and this combination should be effective and well tolerated in 85% to 90% of patients. ACE inhibitors can be used to treat congestive heart failure and to prevent the renal complications of hypertension and diabetes mellitus, significantly expanding their use in patients with these high-risk conditions. They also can be used concurrently with other antihypertensive agents, digitalis, cardiac glycosides, and lithium and are not contraindicated in most of the diseases commonly seen in hypertensive patients.