Angiotensin-converting Enzyme Inhibitors To Treat Hypertension Evidence-based Medicine

Objectives: To determine the efficacy, safety, cost-effectiveness of angiotensin-converting enzyme inhibitors (ACEIs), and their difference in organ protection.Method: We searched Medline; EMBASE; Cochrane library, Chinese biology and medicine(CBM) disc. Identify studies, then abstract relavent data.Main results: most of the studies are multicentre, doubleblind RCTs and Meta-analysis, which have high quality. Effectiveness of antihypertension and organ-protection: 8 kind of ACEIs are all effective when they are used alone in mild and moderate hypertension.Efficacy in turn : Lisinopril, Cilazapril, Captopril ,Fosinopril, benazepril, Ramipril, enalaprol, Perindopril.Once daily administration of ACE inhibitors produced on average ratios higher than 50% with fosinopril, ramipril, enalaprol, cilazapril, and lisinopril. Studies have shown that all kinds of ACEIs are beneficial to chronic heart failure. One study showed fosinopril was safer than captopril in patients with heart failure. Early use(within 36h from the onset) of ACEIs for 4-6 weeks after acute myocardia infarction (AMI) can moderately decrease the overall mortality, save 6.0 per 1,000. Later use of ACEIs ( 3days since onset)can save 53 per 1,000 every 37 months in patients with AMI. ACEIs (captopril, enalaprol, ramipril, perindopril, lisinopril) have advantage of decreasing heart failure after AMI. ACEIs decrease Proteinuria and delay renal deficiency. ACEIs are effective and well tolerance in the elderly. Perindopril and enalaprol have evidence that they can prevent stroke .Safety and compliance: adverse side effects(ASE) of ACEIs is mild except cough. They are hypotension, cough, increase of creatinin, hyperkalemia, rash, etc. Cough is most common. Fosinopril induce cough the least and enalaprol the most in those 8 kinds of ACEIs. Studies didn't show ACEIs influence gluconate, fat or electrolyte.Benazepril and captopril cause overall ASE the most. Tolerance: Perindopril, benazepril > Captopril;, Fosinopril > enalaprol.Once daily administration of ACEIs has good compliance .economics: There are few studies about it. 3 studies in patients with heart failure showed enalaprol is economical. A study indicated that ramipril plus felodipine SR is economical and well tolerated. A small sample study found lisinopril is cheaper than enalaprol.Conclusions: Lots of high quality studies confirmed that ACEIs are effective in antihypertension and preservation of heart, kidney and brain. There is mild difference among them. ACEIs can be well tolerated except dry cough. There is no enough evidence of difference in ASE. There are few studies about economics.