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  • Title: Choosing a first-line drug in the management of elevated blood pressure: what is the evidence? 3: Angiotensin-converting-enzyme inhibitors.
    Author: Wright JM.
    Journal: CMAJ; 2000 Aug 08; 163(3):293-6. PubMed ID: 10951729.
    Abstract:
    Elevated blood pressure is associated with an increased risk of cardiovascular illness and death. Efforts to reduce that risk have led to recommendations for a wide array of nondrug and drug therapies. Choosing the optimal first-line drug for hypertensive patients should address a hierarchy of treatment goals: decrease in morbidity and mortality associated with hypertension, decrease in blood pressure and other surrogate markers, good tolerance, dosing convenience and low cost. This article examines the evidence for angiotensin-converting-enzyme (ACE) inhibitors as a class of first-line antihypertensive drugs in light of these treatment goals. Overall, the evidence does not support the use of ACE inhibitors as first-line drugs in the management of most patients with hypertension, although they have proven benefit as second-line drugs for the treatment of congestive heart failure and left ventricular dysfunction secondary to myocardial infarction.
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