THE CLINICAL PHARMACOLOGY OF ACE INHIBITORS: EVIDENCE FOR CLINICALLY RELEVANT DIFFERENCES?

SUMMARY 1. Potential differences among ACE inhibitors include pharmacokinetic and pharmacodynamic factors. The presence of a sulfhydryl group conferring antioxidant properties, the administration as a pro‐drug to delay the onset and prolong the duration of haemodynamic effects, and the route of elimination are examples of possible differences. 2. Adverse effects of ACE inhibitors may be mediated by effects on bradykinin metabolism at tissue sites, which may be separable from haemodynamic responses mediated largely by angiotensin II withdrawal. 3. Clinically important differences between ACE inhibitors in their adverse event profile have yet to be proven. Evidence is emerging that plasma ACE inhibition and haemodynamic responses are separable, and this may indicate the potential for other organ‐specific effects to differ among ACE inhibitors. 4. At present, however, the greatest distinguishing features for one compound vs another are the time to onset and the duration of action, which determine the frequency of administration.