Gli inibitori dell’enzima di conversione dell’angiotensina: da farmaci vasoattivi a strumento di prevenzione cardiovascolare

Abundant evidence showed that angiotensin-converting enzyme (ACE)-inhibitors reduce longterm cardiovascular morbidity and mortality rates in patients with heart failure and myocardial infarction. More recent studies revealed clinical benefits also in hypertensive patients with comorbidity and lead to an extension of clinical indications. Indeed in patients with severe hypertension differences between drugs are hardly detectable because the risk reduction is mainly related to the control of blood pressure values independent of the type of therapy. Conversely in the presence of comorbid conditions, especially in diabetics, the association of ACE-inhibitors with antihypertensive treatments proved its efficacy in reducing cardiovascular morbidity and mortality so that the role of mechanisms extending beyond blood pressure reduction can be postulated.