2. Benazepril — dosage 5–30 mg daily
3. Cilazapril — dosage 1.25–5 mg daily
4. Enalapril — dosage 5–40 mg once daily
5. Fosinopril — dosage 5–50 mg once daily
6. Lisinopril — dosage 5–40 mg once daily
7. Perindopril — dosage 2–8 mg once daily
8. Quinapril — dosage 5–40 mg once daily
9. Ramipril — dosage 2.5 mg or up to 15 mg once daily
10. Trandolapril — dosage 0.5–4 mg once daily
Although there are more than ten ACE inhibitors currently available, it is unfortunate that their actions, indications, and adverse effects are similar. The newer agents have no beneficial effects over and above that of the older agents captopril, enalapril, and lisinopril that were available during the 1980s; thus the newer agents offer is little added benefit to patients. Although there are subtle differences in absorption, elimination by the liver or kidney, and duration of action, these differences do not cause beneficial effects and do not merit further discussion.
C. Indications
1. Hypertension
These agents are most effective in patients with high serum renin activity. Younger white patients usually have a higher renin activity followed by older white patients, and these agents are particularly effective in the younger white patient. They are less effective in older white patients and, unfortunately, are not effective antihypertensive agents in people of African origin. The antihypertensive effects in patients of Asian and Oriental origin have not been adequately studied. In addition, they cause effective blood pressure lowering in less than 60% of white individuals. The addition of a diuretic stimulates renin activity and increases the antihypertensive effects of ACE inhibitors. Nonetheless, it is not wise to use both agents in patients of African origin because a diuretic alone should suffice, and the addition of an ACE inhibitor should be considered superfluous (see the chapter Hypertension).

Страницы: 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11