Since captopril, the first orally active nonpeptide inhibitor of
ACEIs, was approved in 1986, it has become increasingly
evident that blockade of the renin-angiotensin-aldosterone
system not only decreases blood pressure in hypertensive
patients but also reduces injury to the heart, kidney, brain,
and blood vessels. The ACEIs have been shown in randomized, controlled, clinical trials to decrease mortality and morbidity in congestive heart failure after recent and remote
myocardial infarction, blunt the decline in glomerular filtration rate, reduce incidence of stroke, produce greater regression of left ventricular hypertrophy than non–RAAS-blocking therapies, reduce albuminuria, delay the onset of new
diabetes, and improve endothelial function (see Cushman41
for review). This last effect is thought to occur because of an
inhibition of angiotensin-dependent increase in oxidative
stress and the resulting decrease in nitric oxide activity and
concurrent increase in inflammatory cytokines and chemokines.