Not All Angiotensin-Converting Enzyme Inhibitors Are Equal: Focus on Ramipril and Perindopril

DOI: Abstract: Angiotensin-converting enzyme (ACE) inhibitors are a heterogeneous class, varying in pharmacologic properties, which have different therapeutic impacts on patient SUR¿OHVLQFOXGLQJOLSRSKLOLFLW\WLVVXH±$&(ELQGLQJGXUDWLRQRIDFWLRQKDOIOLIHDQGLQFUHDVHG bradykinin availability. Among the ACE inhibitor class, the agent perindopril, in particular, has pleiotropic effects that are not equally shared by other ACE inhibitors, including bradykinin site selectivity and subsequent enhancement of nitric oxide and inhibition of endothelial cell apoptosis. Moreover, there is a large amount of evidence to suggest that perindopril therapy may reduce cardiovascular event rates in patients, yet perindopril is rarely prescribed in the 8QLWHG6WDWHV5DPLSULO LV DQRWKHU$&( LQKLELWRUZLWKERWKD IDYRUDEOH FOLQLFDOSUR¿OH DQ