Angiotensin-converting enzyme inhibitors in patients with vascular disease.

Angiotensin-converting enzyme inhibitors (ACEIs) have a beneficial effect on oxidative stress, endothelial function, vascular remodelling, and the progression of atherosclerosis in animal experiments independent of their effect on reducing blood pressure. ACEIs have also been shown to decrease cardiovascular mortality and morbidity in patients with vascular disease.1,2 While these results have been adopted into guidelines, there have been doubts as to whether or not these benefits were due to a reduction in blood pressure and therefore possibly any anti-hypertensive strategy might be equally effective or whether they have an effect independent of blood pressure lowering. The answer to this question has important implications. For example, the COURAGE trial3 suggested that optimum medical therapy, including an ACEI, was as effective in preventing cardiovascular events in patients with mild to moderate coronary artery disease as percutaneous coronary angioplasty. The use of ACEIs in patients with coronary artery disease without other clinical indications for their use such as hypertension and/or diabetes mellitus, however, remains suboptimal. Brugts et al. 4 have analysed the effect of an ACEI-based regimen using individual patient data from across a wide spectrum of vascular diseases from the ADVANCE, EUROPA, … *Corresponding author. Tel: +1 734 9365260, Fax: +1 734 936;5256, Email: bpitt{at}umich.edu